J.  G.  AUNER,  < 

BOOKSELLER  AND  STATIONER,    l 

SS3  Market  St,  > 

4  doors  below  Nintli  St.      I 

PHILADELPHIA.  J 


4iP^^mJ&^ 


LOCK  k.U 
CASE 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


,  tfT/l»Tat|atC  Tats 

ib.  XU. 


COMMENTARIES 


HISTORY    AHD    CUBE 


OF 


DISEASES. 


By  WILLIAM  HEBERDEN,  M.D. 


FROM  THE   LAST   LONDON  EDIXrON. 


TtpetVi  KAt  K*[x.niv  ouKiri  Swttfxviog^  rouro  to  /S/Ca/ov  «^g«t4et,  aviret^Af  Tats 
fcirci  TToJiKne  rgiCijs  sv  tak  tw  *v6g«5Tw  vovote  KATAKtxpBua-Ai  (/.at  TrtigAs. 

ALEX.  TRALL,  Lib.  XIF. 


boston: 

FEINTED  BY   WELLS   AND   LILLY. 


1818. 


WILLIAM  HEBERDEN 


Was  born  in  London  in  the  year  1710, 
and  received  the  early  part  of  his  education 
in  that  city.  At  the  close  of  the  year  1734 
he  was  sent  to  Saint  John's  College  in  Cam- 
bridge, and  six  years  after  was  elected  a 
Fellow.  From  that  time  he  directed  his  at- 
tention to  the  study  of  medicine,  which  he 
pursued  partly  at  Cambridge  and  partly  in 
London.  Having  taken  his  degree  of  Doc- 
tor of  Physic  he  practised  in  the  University 
for  about  ten  years,  and  during  that  time 
read  every  year  a  course  of  lectures  on  the 
Materia  Medica.  In  the  year  1746  he  be- 
came a  Fellow  of  the  Royal  College  of  Phy- 
sicians, and  two  years  afterwards,  leaving 
Cambridge,  he  settled  in  London  and  was 
elected  into  the  Royal  Society.  He  very 
soon  got  into  great  business,  which  he  fol- 


[    iv     ] 

lowed  with  unremitting  attention  above 
thirty  years,  till  it  seemed  prudent  to  with- 
draw a  little  from  the  fiitigues  of  his  profes- 
sion. He  therefore  purchased  a  house  at 
Windsor,  to  which  he  used  ever  afterwards 
to  retire  during  some  of  the  summer  montlis ; 
but  returned  to  London  in  the  winter,  and 
still  continued  to  visit  the  sick  for  many 
years. 

In  1766  he  recommended  to  the  College 
of  Physicians  the  first  design  of  the  Medi- 
cal Transactions,  in  which  he  proposed  to 
collect  together  such  observations  as  might 
have  occurred  to  any  of  their  body,  and  were 
likely  to  illustrate  the  history  or  cure  of  dis- 
eases. The  plan  was  soon  adopted,  and 
three  volumes  have  successively  been  laid 
before  the  public.  In  1778  the  Boyal  So- 
ciety  of  Medicine  in  Paris  chose  him  into 
the  number  of  their  Associates.  Besides 
the  observations  contained  in  the  present 
volume,  Doctor  Heberden  was  the  author 
of  several  papers  in  the  Medical  Transac- 
tions, and   of  some    in   the    Philosophical 


I     V     ] 

Transactions  of  the  Royal  Society.  He  de- 
clined all  professional  business  several  years 
before  his  death,  which  was  mercifully  post- 
poned till  the  year  1801,  when  he  was  ad- 
vancing to  the  age  of  ninety-one. 

From  his  early  youth  he  had  always  en- 
tertained a  deep  sense  of  religion,  a  con- 
summate love  of  virtue,  an  ardent  tliirst  af- 
ter knowledge,  and  an  earnest  desire  to  pro- 
mote tlie  welfare  and  happiness  of  all  man- 
kind. By  these  qualities,  accompanied  with 
great  sweetness  of  manners,  he  acquired 
the  love  and  esteem  of  all  good  men,  in  a 
degree  which  perhaps  very  few  liave  expe- 
rienced ;  and  after  passing  an  active  life 
with  the  uniform  testimony  of  a  good  con- 
science, he  became  an  eminent  example  of 
its  influence,  in  the  cheerfulness  and  sere- 
nity of  his  latest  age. 


FREFACIE. 


Plutarch  says,^  that  the  life  of  a  vestal  vir- 
gin was  divided  into  three  portions ;  in  the  first  of 
which  she  learned  the  duties  of  her  profession,  in 
the  second  she  practised  them,  and  in  the  third  she 
taught  them  to  others.  This  is  no  bad  model  for 
the  life  of  a  physician :  and  as  I  have  now  passed 
through  the  two  first  of  these  times,  I  am  willing 
to  employ  the  remainder  of  my  days  in  teaching 
what  I  know  to  any  of  my  sons  who  may  choose 
the  profession  of  physic ;  and  to  him  I  desire  that 
these  papers  may  be  given. 

The  notes,  from  which  the  following  observa- 
tions were  collected,  were  taken  in  the  chambers 
of  the  sick  from  themselves,  or  from  their  atten- 
dants, where  several  things  might  occasion  the 
omission  of  some  material  circumstances.  These 
notes  were  read  over  every  month,  and  such  facts, 
as  tended  to  throw  any  light  upon  the  history  of  a 
distemper,  or  the  effects  of  a  remedy,  were  enter- 
ed under  the  title  of  the  distemper  in  another 
book,  from  which  were  extracted  all  the  particu- 
lars here  given,  relating  to  the  nature  and  cure  of 

*  Plutarch  in  Numa,  et  «  7rt^a<wrt^a  TroKtnvr. 


[    viii    ] 

diseases.  It  appeared  more  advisable  lo  give  such 
facts  only,  as  were  justified  by  the  original  pa- 
pers, however  imperfect,  than  either  to  supply 
their  defects  from  memory,  except  in  a  very  few 
instances,  or  than  to  borrow  any  thing  from  other 
writers. 

The  collections  from  the  notes,  as  well  as  the 
notes  themselves,  were  written  in  Latin,  the  dis- 
eases being  arranged  alphabetically :  and  this  is 
the  reason  that  the  titles  are  here  in  that  language. 
In  making  the  extracts,  it  was  not  only  more  easy 
to  follow  the  order  in  which  the  observations  had 
been  ranged,  but  there  was  likewise  less  danger  of 
any  confusion  or  omission ;  and  little  or  no  incon- 
venience can  arise  from  preserving  the  Latin  names 
of  the  distempers. 

An  useful  addition  might  have  been  made  to 
these  papers  by  comparing  them  with  the  current 
doctrine  of  diseases  and  remedies,  as  also  with 
what  is  laid  down  in  practical  writers,  and  with  the 
accounts  of  those  who  treat  of  the  dissections  of 
morbid  bodies ;  but  at  my  advanced  age  it  would 
be  to  no  purpose  to  think  of  such  an  undertaking. 

August  1782. 


CONTENTS. 


Chapter. 

Page. 

Cliipter. 

Page. 

'•  Of  Diet       .     .     .     . 

1 

25.  Devoratio     .     . 

.     .     Ill 

2.  Ratio  Medendi     .     .     . 

4 

26.  Diabetes        .     . 

.     .     113 

3.  Abdomen        .... 

11 

27.  Diarrhoea       .     . 

.     .     116 

4.  Abortus 

12 

28,  Digitorum  Nodi 

.     .     119 

5.  Alvus 

13 

29.  Dolor        .     .     . 

.     .     120 

6.  Aneurysma     .... 

15 

30.  Dolores  vagi 

.     .     122 

7.  Angina,  and  Scarlet  Fe- 

31. Dysenteria    .     . 

.     .     123 

ver      

15 

32.  Ebrietas        .     . 

.     .     125 

8.  Aphthae 

25 

33.  Epilepsia      .     . 

.     .     126 

9.  Arthritis 

26 

34.  Erysipelas     .     . 

.     .     135 

10.  Ascarides      .... 

49 

35.  Essera,  or  Nettle-R 

ash     137 

11.  Asthma 

50 

36.  Expergefacti  cum  ( 

:ia- 

12.  Aurium  Morbi   .     .     . 

56 

more  et  Terrore 

.     .     140 

13.  Of  the  Bath  Water    . 

58 

37.  Febris      .     .     . 

.     .     141 

14.  Of  the  Bristol  Water 

64 

38.  Febris  Intermittens 

5     .     146 

15.  Bronchocele      .     .     . 

64 

39.  Febris  Hectica 

.     150 

16.  Calculus  Urinse      .     . 

65 

40.  Fistula  Ani   .     . 

.     160 

17.  Capitis  Dolor    .     .    . 

74 

41.  Fluor  Albus       .     . 

.     161 

18.  Capitis  Dolores  inter- 

42.  Gonorrhoea  Mitis    . 

.     165 

mittentes     .... 

80 

43.  Graviditas     .     .     . 

.     166 

19.  Carbunculus      .    •     . 

82 

44.  Haemorrhoides  .     . 

.     168 

20.  Chorea  Sancti  Viti     . 

83 

4i».  Hernia     .     .    .     . 

.     172 

21.  Coxae  Morbus  et  Exul- 

46.  Hydrocephalus 

.     172 

ceratio 

86 

47.  Hydrophobia     .     . 

.     173 

22.  Crurum  Dolor,  Tumor, 

48.  Hydrops        .     .     . 

.     173 

Inflammatio,    et    Ul- 

49. Hypochondriacus 

et 

cus      

87 

Hystericus      Affecl 

tus     180 

23.  Cutis  Vitia    .... 

90 

50.  Icterus,  aliique  Hej 

)a- 

24.  Destillatio    .... 

108 

tis  Affectus       .    . 
B 

.     189 

CONTENTS. 


Chapter.  Page. 

51.  Ileus 210 

52.  Inflatio  et  Riictus  .     .  220 
63.  lusania 221 

54.  Intestinorum    Dolores  224 

55.  Ischuria 227 

56.  Linguae  et  Oris  Dolor  230 

57.  Lipothymia,  or  Faint- 

ing        230 

58.  Lumborum  Dolor  .     .  232 

59.  Ldimbrici       ....  233 
60    Lyinphalicae  Glandulae  235 

61.  Mammae 236 

62.  Menstrua      ....  241 

63.  Morbilli    .     .     .     .     .  252 

64.  Narium  Haemorrhagia  260 

65.  Nausea 262 

66.  Oculorum  Morbi     .     .  263 
Of  the  Nyctalopia,  or 
Night-blindness     .     .  269 

67.  Ozaena,  or  a  Suppura- 

tion of   the   Antrum 

Highmori     ....  271 

68.  Pal  pi  tatio  Cordis    .     .  271 

69.  Paralysis  et  Apoplexia  273 

A  Case  of  Catalepsy  291 

70.  Pectoris  Dolor        .     .  292 

71.  Pedicularis  Morbus     .  298 

72.  Phthisis  Pulmonum    .  299 

73.  Pictonum  Colica    .     .  309 

74.  Pituita 314 

75.  Prostatas  Scirrhus  .     .  315 

76.  Pruritus  Cutis   ...  317 

The  Conclusion 


Chapter. 

77.  Puerperium       .     .     . 

78.  Purpureae  Maculae 

79.  Rheumatismus        .     . 

80.  Semen  Virile     .     .     . 

81.  Singultus      .     .     .     . 

82.  Sitis 

83.  Spasmus 

84.  Sputa  rruenta   .     .     . 

85.  Steatomata        .     .     . 

86.  Stranguria     .     .     .     . 

87.  Struma 

88.  Tenesmus      .     .     .     . 

89.  Testiculus     .     .     .     . 

90.  Torpor 

91.  Tremor 

92.  Tussis 

93.  Tussis  conyulsi?a  .     . 

94.  Yaletudo   conquassata 

95.  VariolaB 

96.  Variolas  Pusillae.    The 
Chicken  Pox     .     .     . 

97.  Ventriculi  Morbi. 

$  1.  Ardor  et  Acer     . 
§2.  Dolor     .     .     .     . 
§  3.  Lienis  Morbi 
§4.  Pancreatis  Morbi 

98.  Vertigo 

99.  Vomitus 

100.  Vox 

101.  Urina 

102.  Uterus 


Page* 
318 
319 
320 
326 
327 
328 
329 
332 
335 
335 
338 
343 
343 
345 
347 
348 
350 
352 
353 

361 
366 
366 
368 
370 
372 
373 
376 
380 
381 
387 


390 


I 


CONTENTS.  XI 

APPENDIX. 

1.  A  Sketch  of  a  Preface,  designed  for  the  Medical  Transactions, 

1767         . .  p.  393 

2.  Observations  on  the  Chronical  Rheumatism                .  402 

3.  Remarks  on   the   Pulse 406 

4.  On  opening  a  Vein  in  Haemorrhages        .                         .  414 


English  Index .417 


COMMENTARIES 


ON   THE 


HISTORY  AND  CURE   OP   DISEASES. 


CHAPTER  1. 
Of  Diet. 

JMany  physicians  appear  to  be  too  strict  and  par- 
ticular in  the  rules  of  diet  and  regimen,  which 
they  deliver  as  proper  to  be  observed  by  all  who 
are  solicitous  either  to  preserve  or  recover  their 
health.  The  too  anxious  attention  to  these  rules 
hath  often  hurt  those  who  are  well,  and  added 
unnecessarily  to  the  distresses  of  the  sick.  The 
common  experience  of  mankind  will  sufficiently 
acquaint  any  one  with  the  sorts  of  food  which  are 
wholesome  to  the  generality  of  men  ;  and  his  own 
experience  will  teach  him  which  of  these  agrees 
best  with  his  particular  constitution.  Scarcely 
any  other  directions  beside  these  are  wanted,  ex- 
cept that,  as  variety  of  food  at  the  same  meal, 
and  poignant  sauces,  will  tempt  most  persons  to 
eat  more  than  they  can  well  digest,  they  ought 
therefore  to  be  avoided  by  all  who  are  afflicted 
with  any  chronical  disorder,  or  wish  to  keep  free 

I 


2  Commentaries  on  the 

from  them.  But  whether  meat  should  be  boiled, 
or  roasted,  or  dressed  in  any  other  plain  way, 
and  what  sort  of  vegetables  should  be  eaten  with 
It,  I  never  jet  met  with  any  person  of  common 
sense  (except  in  an  acute  illness)  whom  I  did  not 
think  much  fitter  to  choose  for  himself,  than  I  was 
to  determine  for  him.  Small  beer,  where  it 
agrees,  or  water  alone,  are  the  properest  liquors 
at  meals.  Wine  or  spirits  mixed  with  water  have 
gradually  led  on  several  to  be  sots,  and  have  ruin- 
ed more  constitutions  than  ever  were  hurt  by 
small  beer,  from  its  first  invention. 

In  fevers  a  little  more  restraint  is  necessary, 
but  not  so  much  as  is  often  enjoined.  The  strong- 
er sorts  of  meat  and  fish  are  most  usually  loathed 
by  the  sick  themselves,  nor  could  they  be  eaten 
without  offending  the  stomach,  and  increasing  the 
distemper,  while  it  is  at  all  considerable ;  but  in 
its  decline,  the  sick  are  often  desirous  of  some  of 
the  milder  sorts  of  meat,  and  no  harm  follows 
from  indulging  their  desire.  The  English  nation 
are  said  to  eat  more  meat  when  they  are  well  than 
most  others ;  but  were  remarkable,  so  long  ago 
as  the  time  of  Erasmus,  for  avoiding  it  more  scru- 
pulously when  they  are  sick,  than  any  other  peo- 
ple. How  high  soever  the  fever  be,  the  sick  may 
safely  be  nourished  with  weak  broths  and  gellies, 
and  with  any  vegetable  substances,  if  we  except 
the  acrid  and  aromatic,  or  with  the  infusions  or 
decoctions  prepared  from  them ;  and  I  know  no 
reason  for  preferring  any  of  these  to  the  rest. 
Ej.';gs  and  milk  have  been,  I  know  not  by  what 
authority,  forbidden  in  all  fevers ;  but,  as  far  as 
my  experience  goes,  they  both  afford  innocent 


History  and  Cure  of  Diseases,         3 

food  in  the  worst,  where  they  are  grateful  to  the 
patients. 

The  feverish  thirst  is  best  allayed  by  pure 
water,  which  may  be  drunk  either  warm,  or  cold, 
at  the  option  of  the  sick  person,  and  he  may  drink 
as  much  as  he  pleases;  but  I  see  no  advantage  in 
persuading  him  to  gorge  himself  with  liquids,  as 
is  often  done,  against  his  inclination  and  stomach* 
If  water  be  deemed  too  insipid,  currant  gelly,  and 
a  variety  of  syrups,  may  be  dissolved  in  it;  or 
apples  sliced  *or  roasted,  tamarinds,  sage,  or  balm, 
or  toasted  bread,  may  be  infused  in  it ;  or  decoc- 
tions may  be  made  of  oatmeal,  barley,  or  rice  ;  or 
the  water  may  be  made  into  an  emulsion  with 
the  oily  seeds  ;  all  which,  with  a  variety  of  simi- 
lar substances,  merely  correct  its  insipidness,  but 
in  other  respects  leave  it  just  what  it  was. 

There  is  scarcely  any  distemper,  in  every  stage 
of  which  it  may  not  be  safely  left  to  the  patient's 
own  choice,  if  he  be  perfectly  in  his  senses,  whe- 
ther he  will  sit  up,  or  keep  his  bed.  His  strength 
and  his  ease  are  chiefly  to  be  attended  to  in  set- 
tling this  point ;  and  who  can  tell  so  well  as  him- 
self, what  his  ease  requires,  and  what  his  strength 
will  bear  ? 

Doubts  are  often  raised  about  the  propriety  of 
changing  the  linen  in  sickness,  just  as  there  have 
been  about  changing  the  foul  air  of  the  sick  cham- 
ber by  any  of  the  means  which  could  refresh  and 
purify  it.  There  can  be  very  little  reason  to  fear 
any  mischief  from  the  cold  which  the  sick  may 
feel  while  their  clean  linen  is  putting  on ;  for  their 


4  ^  Commentaries  on  the 

attendants,  with  common  care,  will  do  this  as  safe- 
ly as  many  other  things  which  must  necessarily 
be  done  for  them.  But  some  have  a  strange  opi- 
nion of  harm  from  the  smell  of  the  soap  perceiva- 
ble in  linen  after  it  has  been  washed,*  and  there- 
fore allow  not  their  patients,  when  they  change 
their  linen,  ever  to  put  on  fresh,  but  such  only  as 
has  been  worn,  or  lain  in,  by  otiier  persons.  By 
this  contrivance  indeed  the  smell  of  the  soap 
might  be  taken  off,  but  few  cleanly  people  would 
think  they  gained  any  advantage  by  the  change. 
Now,  if  a  faint  smell  of  soap  were  noxious,  then 
soap-makers,  and  laundry-servants,  must  be  re- 
markably unhealthy ;  which  is  contrary  to  expe- 
rience :  nor  is  it  less  so,  that  the  sick  are  injured 
by  the  cleanness  of  what  they  wear ;  on  the  con- 
trary, the  removing  of  their  foul  things  has  often 
diffused  over  them  a  sense  of  ease  and  comfort, 
which  has  soon  lulled  them  into  a  quiet  and  re- 
freshing sleep. 


CHAPTER  2. 

Matio  Medendi, 

One  of  the  first  considerations  in  the  cure  of  a 
disease  is,  whether  it  require  any  evacuations ; 
that  is,  whether  it  have  been  the  general  opinion 
of  practical  authors,  that  emetics,  cathartics, 
diuretics,  bleeding  (by  leeches,  cupping-glasses, 
or  the  lancet,)  sudorifics,   blisters,  issues,  sternu- 

*  Diemerbroeck  de  Peste,  I.  ii.  c.  3.  aupot.  6. 


History  and  Cure  of  Diseases.         5 

tatories,  or  salivation,  have  in  similar  cases  been 
found  to  be  beneficial. 

2dly.  Whether  it  be  a  distemper,  for  which 
any  specific,  or  certain  remedy,  has  been  found 
out.  Many  such  in  all  ages,  and  in  every  coun- 
try, have  been  for  a  httle  while  in  fashion ;  very 
few  of  which  have  justified  the  promises  of  their 
patrons,  and  answered  the  wishes  of  physicians 
and  patients  :  so  that  there  is  no  where  more  rea- 
son to  be  upon  our  guard,  and  to  remember  the 
old  caution,  mipsKxi^nfcvocauTirtirTuv.  However,  the 
honour  of  this  title  may  be  justly  claimed  by  the 
Peruvian  bark  for  the  cure  of  agues ;  quicksilver 
for  Venereal  disorders ;  sulphur  for  tlie  itch  ;  and 
perhaps  opium  for  some  spasms  ;  and  Bath  waters 
for  the  injury  done  to  the  stomach  by  drink- 
ing. 

Besides  the  [ew  remedies  here  mentioned,  it 
may  be  doubted  whether  ten  others  have  upon 
any  good  authority  been  reputed  specifics,  or 
certain  remedies  for  particular  diseases,  the  repu- 
tation of  which  has  afterwards  been  sufl[iciently 
confirmed  by  experience.  Borax  has  been  cele- 
brated as  such  for  aphthae ;  the  Portland  powder 
for  the  gout ;  squills  and  the  fetid  gum-resins  for 
the  asthma ;  soap-ley  for  the  gravel  and  stone ; 
hemlock  for  cancers  ;  electrification  for  blindness  ; 
antimony  for  continual  fevers ;  sugar  of  lead  for 
haemorrhages ;  and  some  few  others  for  other  dis 
tempers. 

Though,  among  the  pretended  specifics,  some 
have  very  little  virtue,  and  others  may  be  incon- 
stant in  their  operations  j  yet,  if  a  physician  be 


6  Commentaries  on  the 

satisfied  that  they  are  safe,  there  may  be  many 
occasions  when  he  may  with  propriety  employ 
them. 

3dly.  Vomiting,  purging,  pain,  and  other  trou- 
blesome symptoms,  are  in  many  cases  so  urgent, 
as  to  make  some  present  relief  indispensably  re- 
quisite ;  for  the  procuring  of  which,  opium  is  very 
commonly  the  most  effectual  means. 

4thly.  In  long  and  obstinate  diseases,  in  which 
no  particular  remedy  is  found  to  have  succeeded, 
it  is  often  advisable  to  have  recourse  to  the  gene- 
ral means  of  strongly  affecting,  and  of  making 
considerable  changes  in  the  state  of  the  body  ;  in 
hopes,  by  this  shock,  of  dislodging  the  cause  of 
the  disease.  For  this  end,  mercury,  antimony, 
hemlock,  and  electrification,  are  sometimes  em- 
ployed. 

Lastly,  where  there  is  no  room  for  any  thing 
else,  there  it  is  the  duty  of  a  physician  to  exert 
himself  as  much  as  possible  in  supporting  the 
powers  of  life,  by  strengthening  the  appetite  and 
digestion,  and  by  providing  that  the  stools,  and 
sleep,  and  every  other  article  of  health,  shall  ap- 
proach as  nearly  as  may  be  to  its  natural  state. 

There  may  be  such  a  state  of  *a  distemper,  in 
which  the  whole  attention  of  the  physician  must 
be  given  up  to  the  supporting  and  enlivening  the 
vital  powers  ;  but  there  can  be  no  stage  of  any 
disease,  which  does  not  require  some  attention  to 
this  important  point.  As  this  is  a  precept,  in  the 
due  observance  of  which  the  welfare  of  every  pa- 


History  and  Cure  of  Diseases,         7 

tient  is  deeply  interested,  it  will  be  worth  while 
to  say  something  more  upon  this  subject. 

To  i*c^fca)9—^vx,n—Arch?dus — spiritus  anitnales- — 
Natura — 

These  and  various  other  terms  have  been  em- 
ployed to  denote  the  principle  of  life,  or  that  un- 
known energy,  whicn  makes  the  difference  be- 
tween an  animated  body,  and  an  inanimate  mass 
of  matter. 

In  the  physiology  and  pathology  of  the  human 
body,  there  has  been  perhaps  both  too  much  and 
too  little  use  made  oi  that  vital  principle  which 
constitutes  the  animal.  Some  have  pretended  to 
a  knowledge  of  it  much  beyond  what  we  have 
hitherto  attained,  and  have  employed  it  in  the 
ministry  of  the  animal  economy,  and  in  explaining 
the  causes  and  cures  of  diseases,  guided  much 
more  by  their  own  fancies  and  speculations,  than 
by  the  authority  of  facts  and  experience  ;  while 
others,  in  accounting  for  the  same  appearances, 
have  overlooked  the  laws  and  powers  peculiar  to 
animal  life,  and  have  endeavoured  to  solve  all  dif- 
ficulties by  the  common  mechanical  powers,  and 
by  the  general  properties  of  dead  matter. 

Whatever  animation  be,  experience  has  un- 
doubtedly acquainted  us  with  several  means  both  of 
deadening,  and  of  invigorating  its  operations.  Of 
the  first  sort  is  in  an  eminent  degree  the  fox-glove, 
and  all  the  narcotic  poisons  ;  to  the  second  be- 
long wine  and  spirituous  liquors,  all  strengtheners 
of  the  stomach,  aromatics,  and  every  thing  ca- 


8  Commentaries  on  the 

pable  of  irritating  the  senses.  But  vinous  liquors 
in  a  certain  quantity  oppress,  and  some  of  the 
narcotics  in  a  small  dose  exhilirate  the  powers  of 
life. 

Many  of  the  narcotics  being  applied  in  a  small 
wound,  to  any  part  of  the  surface  of  the  body, 
will  have  their  full  effect  in  damping  or  destroying 
the  vital  energy  ;  but  most  of  them,  and  almost 
all  of  the  opposite  class,  exert  their  powers  only 
when  taken  down  into  the  stomach ;  the  control 
and  dominion  of  which  part  over  the  principle  of 
animation  throughout  the  whole  body  are  such, 
that  universal  refreshment  and  invigoration,^  or 
faintness  and  death  itself,  will  be  the  instanta- 
neous effects  of  its  being  touched  by  certain 
friendly  or  injurious  substances. 

In  all  distempers  it  is  one  part  of  the  physician's 
duty  to  remove  or  relieve,  as  far  as  can  safely  be 
done,  the  present  inconveniences:  but' the  mis- 
chief principally  to  be  dreaded  in  every  illness  is 
its  tendency  to  destroy  life ;  and  against  this  the 
patient  is  most  solicitously  to  be  guarded.  Now 
of  the  means  before  mentioned  by  which  the  vires 
vitae  can  be  supported  and  strengthened,  great  ir- 
ritations of  the  senses  can  only  afford  a  momenta- 
ry relief  in  sudden  languors  and  faintings.  Wine 
and  aromatics  will  indeed  make  a  more  lasting  im- 
pression on  the  stomach,  and  in  many  languid  ill- 
nesses may  be  administered  w^ith  great  advantage ; 
but  they  must  be  used  with  caution,  as  the  vinous 
liquors  may  intoxicate,  and  both  of  them  in  many 
distempers  may  excite  too  great  a  degree  of  heat. 
Dr.  Morton's  practice  in  the  last  century  has  been 


History  and  Cure  of  Diseases.        9 

much  censured  for  his  method  of  cure  by  an  im- 
moderate use  of  aromatics,  for  the  purpose,  as 
he  says,  of  exciting  and  expanding  the  spiritus 
animales.  A  freer  use  may  safely  be  made  of  the 
mild  astringents  and  bitters,  and  there  are  per- 
haps few  disorders  in  vvhicli  they  would  not  make 
very  useful  associates  of  other  medicines.  Camo- 
mile flowers  in  powder  are  sufficiently  grateful  to 
the  stomach;  but  light  infusions  of  the  barks,  and 
woods,  and  roots,  are  preferable  to  their  powders. 
Of  this  very  numerous  class  of  simples  a  great 
variety  of  medicines  may  be  made;  but  none  per- 
haps better,  than  an  infusion  made  by  one  ounce  of 
the  Peruvian  bark  and  one  dram  of  the  root  of 
gentian,  put  into  a  pint  of  boiling  water.  I  hardly 
know  that  distemper  in  which  two  ounces  of  this 
infusion  might  not  be  taken  twice  a  day  with 
safety,  and,  I  believe,  with  advantage. 

The  Peruvian  bark  has  been  more  objected  to 
than  any  other  of  these  medicines  in  cases  of  con- 
siderable inflammation,  or  where  a  free  expecto- 
ration is  of  importance;  for  it  is  supposed  to  have, 
beyond  any  other  stomach  medicine,  such  a  strong 
bracing  quality,  as  to  tighten  the  fibres  still  more, 
which  were  already  too  much  upon  the  stretch  in 
an  inflammation,  and  its  astringency  has  been  judg- 
to  be  the  likely  means  of  checking  or  putting  a  stop 
to  expectoration.  All  this  appearecl  much  more 
plausible  when  taught  in  the  schools  of  physic, 
than  probable  when  I  attended  to  fact  and  experi- 
ence. The  unquestionable  safety  and  acknowledg- 
ed use  of  the  bark  in  the  worst  stage  of  an  inflam- 
mation, when  it  is  tending  to  a  mortification, aflbrds 
a  suflicient  answer  to  the  first  of  these  objections  ; 


iO  Commentaries  on  the 

and  I  have  several  times  seen  it  given  plentifully 
in  the  confluent  small  pox,  without  lessening  in 
any  degree  the  expectoration.  An  asthma,  which 
seemed  to  be  near  its  last  stage,  became  very  lit- 
tle troublesome  for  several  years,  during  which 
the  patient  took  two  scruples  of  the  bark  every 
morning  and  night.  If  great  care  be  taken  not 
to  give  it  in  such  a  manner  as  to  load  or  oppress 
the  stomach,  every  reasonable  objection  would,  in 
my  judgment,  be  removed,  to  the  giving  of  it  in 
any  distemper  whatever.  For  the  purpose  now 
under  consideration,  its  efficacy  is  the  same  with 
any  other  bitters,  but  some  preference  may  per- 
haps be  due  to  this  simple  on  account  of  its  friend- 
ly powers  to  the  human  body,  manifested  in  its 
being  a  specific  remedy  for  intermittents  :  but  if 
any  one  cannot  quiet  his  own  or  his  patient's  ap- 
prehensions of  some  lurking  mischief  in  the  Peru- 
vian bark,  any  other  mild  bitter*  may  be  used  for 
the  same  purpose  of  enabling  nature  to  struggle 
successfully  with  the  malady,  by  invigorating  the 
principle  of  animation  in  the  stomach.  Too  much 
attention  can  never  be  paid  to  this  very  important 
article  of  a  just  method  of  treating  a  patient; 
every  distemper  requires  it,  and  in  many  it  is  all 
that  a  physician  can  do. 

It  is  a  most  alarming  stage  of  any  illness,  when 
the  stomach  has  so  entirely  lost  its  powers,  that 
the  person  is  averse  from  taking  every  thing  that 

*  Such  as  a  few  grains  of  camomile  flowers  powdered  in  a  neu- 
tral saline  draught ;  or  an  aromatic  confijction  draught  may  be 
made  up  with  a  weak  infusion  of  qiiassia  wood,  or  columbo  root ; 
or,  if  it  be  made  up  with  any  distilled  water,  twenty  drops  of  the 
tincture  of  gentian,  or  of  columbo  root,  may  be  added  to  each 
draught. 


History  and  Cure  of  Diseases.         11 

is  offered ;  as  if  nature  were  conscious  that  the 
vital  powers  were  too  nearly  extinguished  to  be 
recoverable  by  any  means,  and  therefore  all  were 
rejected  :  this  death  of  the  stomach  never  fails  to 
be  soon  succeeded  by  an  universal  loss  of  life. 


CHAPTER   3. 

Abdomen, 

The  abdomen  has  been  observed  to  swell  from 
various  other  causes  besides  the  more  common 
ones  of  a  dropsy  either  in  the  belly  or  ovaries,  of 
pregnancy,  or  scirrhi  of  some  of  the  viscera,  or 
flatulence.  The  hard  swelled  bellies  of  children 
continue  too  long  to  be  owing  to  flatulence,  and 
they  yield  too  soon  to  purging  medicines  to  be 
occasioned  by  schirri.  Upon  the  total  ceasing  of 
the  menstrua,  or  upon  a  temporary  obstruction  of 
them,  the  abdomen  will  often  be  swelled,  and  con- 
tinue so  for  some  months.  Women  not  uncom- 
monly complain  of  such  tumours  after  miscar- 
riages, or  after  being  brought  to  bed.  Many  of 
these  swellings  are  probably  owing  to  some  secret 
power  of  the  nerves,  which  they  frequently  exert 
when  disturbed  by  several  poisons.  They  have 
in  some  persons  been  known  to  continue  for  two 
or  three  years ;  and,  after  a  violent  head  acb,  the 
whole  body  has  swelled,  and  subsided  within  an 
hour.  Very  large  swellings,  continuing  for  two 
or  three  days,  have  been  known  to  attend  the  at- 
tacks of  the  essera,  or  nettlerash.  It  has  often 
happened  to  the  same  person  to  have  a  tumour  of 


12  Commentaries  on  the 

the  abdomen  disappear  upon  the  sudden  gushing 
of  about  a  pint  of  water  from  the  uterus.  In  one 
person,  whose  abdomen  had  been  swelled  for  two 
or  three  years,  a  sudden  swelhng  would  often  rise 
up  in  other  parts,  as  on  the  thighs,  back,  and  tho- 
rax, quite  up  to  the  neck.  A  tumour  half  as 
big  as  a  child's  head  would  suddenly  rise  up  in 
the  same  patient's  neck ;  and  though  the  swelling 
of  the  belly  never  totally  disappeared,  yet  it  would 
sometimes  in  a  morning  be  hardly  perceivable, 
and  in  an  instant  the  whole  abdomen  would  be- 
come so  distended  that  the  skin  seemed  ready  to 
break.  She  often  felt  something  move  from  the 
stomach  to  the  limbs,  which  were  immediately 
convulsed. 

There  often  occur  pains  in  the  abdomen,  simi- 
lar to  those  which  are  frequently  felt  in  the  tho- 
rax, in  which  the  viscera  seem  not  at  all  concern- 
ed, but  which  are  rather  of  a  rheumatic  nature, 
and  will  continue  for  a  very  long  time.  The  re- 
medies are— the  volatile  liniment,  with,  or  with- 
out, the  addition  of  laudanum ;  empl.  cymini ;  a 
perpetual  blister;  an  oily  draught,  with  as  much 
volatile  salt  as  can  easily  be  borne  ,*  opium ;  and 
all  the  rheumatic  medicines. 


CHAPTER   4. 

Mortus. 

One  woman  miscarried  five-and-thirty  times* 
Though  the  third  month  be  most  usually  the  time 


History  and  Cure  of  Diseases.        13 

of  miscarrying,  jet  there  are  some  women  who  con- 
stantly miscarry  about  the  fifth  or  sixth  month; 
and  in  these  the  milk  running  out  of  their  breasts 
is  a  sign  of  the  approaching  miscarriage.  A  wo- 
man who  was  with  child  of  twins,  miscarried  of 
one  at  the  end  of  tliree  months,  but  went  on  with 
the  other,  who  was  born  at  the  proper  time,  and 
lived  to  maturity.  Abortions  are  the  effects  of  ac- 
cidents, of  mal-conformation,  and  of  ill  health :  if 
frequently  repeated,  they  are  also  the  causes  of 
ill  health,  and  occasion  the  fluor  albus,  and  the 
whole  train  of  evils  belonging  to  what  is  called 
the  hysteric  passion,  and  likewise  those  vihich 
are  enumerated  under  the  article  of  a  broken  con- 
stitution* One  woman,  after  frequent  abortions, 
took  for  a  long  time  three  drams  of  bark  in  a  day 
while  she  was  breeding,  and  went  her  time,  and 
brought  forth  the  strongest  of  all  her  children. 


CHAPTER   9, 

Mvus, 

A  VERY  great  difference  is  observable  in  diffe- 
rent constitutions  in  regard  to  the  evacuation  by 
stool.  One  man  never  went  but  once  in  a  month  : 
another  had  twelve  stools  every  day  for  thirty 
years,  and  afterwards  seven  in  a  day,  for  seven 
years,  and  in  the  mean  time  did  not  fall  away,  but 
rather  grew  fat. 

The  faeces  sometimes  lie  in  the  rectum  for  many 
months,  and  are  collected  into  a  large  hard  mass, 

*  Chap.  94. 


14  Commentaries  on  the 

which  cannot  be  voided  without  the  help  of  a  sur- 
geon. The  signs  of  this  are,  pains  in  the  belly ; 
a  constant  desire  to  go  to  stool,  even  just  after  an 
evacuation ;  none  but  hquid  faeces  are  ever  void- 
ed ;  and  the  disorder  is  attended  with  a  difficulty 
of  making  water. 

The  inner  coat  of  the  rectum  is  sometimes  so 
relaxed  as  to  come  out  after  every  stool,  and  in 
riding,  and  will  not  go  up  again  without  the  assis- 
tance of  the  hand  :  an  astringent  fomentation  may 
be  applied  with  some  advantage  after  every  stool. 

With  the  tape-worm,  and  with  the  ascarides, 
there  is  a  most  troublesome  and  almost  intolera- 
ble itching  of  the  fundament  towards  night. 

Great  pains  are  not  uncommonly  felt  in  the 
anus,  which  are  sometimes  relieved,  but  oflener 
exasperated,  by  stool,  and  are  not  unfrequently 
worse  in  bed  than  in  the  day  time,  and  even  then 
in  walking  or  riding ;  and  in  this  state  they  will 
last  several  years.  A  small  blister  kept  open 
upon  the  thigh  for  two  or  three  months  has  cured 
this  disorder.  These  pains  sometimes  proceed 
from  an  inflammation,  and  are  aggravated  to  an 
almost  intolerable  degree  by  sitting,  standing, 
coughing,  sneezing,  or  making  water.  Where 
the  inflammation  has  suppurated,  the  healing  of 
the  abscess  will  in  some  constitutions  be  succeed- 
ed by  broken  health,  or  by  a  fatal  pulmonary  con- 
sumption ;  whether  it  be  because  the  disorder  at 
first  was  not  merely  local,  or  because  the  habit  of 
body  became  diseased  by  the  too  long  continuance 
of  the  ulcer  before  it  was  properly  opened  and 


History  and  Cure  of  Diseases,       15 

healed.  In  order  to  prevent  these  mischievous 
consequences,  it  is  often  advisable  to  open  an  is- 
sue as  soon  as  the  abscess  begins  to  heal.* 


CHAPTER  6. 

jinetirysma, 

Aneurysmatic  tumours  of  the  neck  will  often 
continue  for  many  years,  attended  with  some  de- 
gree of  difficulty  in  breathing,  and  at  last  end  in 
sudden  death.  Many  tumours  of  the  neck,  appa- 
rently of  this  sort,  from  having  a  strong  pulsation 
in  them,  have  after  several  years  spontaneously 
decreased,  till  at  last  they  have  almost  disap- 
peared. 


CHAPTER  7. 

jlngina^  and  Scarlet  Fever, 

The  scarlet  fever  begins  with  the  common 
symptoms  of  other  fevers.  On  the  first  or  second 
day  an  unusual  redness  appears  on  the  skin,  and 
there  is  a  slight  pain  of  the  throat.  At  the  same 
time  in  some  patients  there  are  swellings  under 
each  ear,  or  in  other  glands,  which  are  not  always 
dispersed  without  coming  to  suppuration.  In  oth- 
ers, the  arms,  and  particularly  the  fingers,  have 
swelled ;  which  swellings  have  happened  indiffe- 

*  See  chap.  40,  on  the  Fistula. Ani. 


16  Commentaries  on  the 

rently,  both  where  the  disease  hath  proved  gen- 
tle, and  where  it  hath  been  fatal.  On  the  third 
or  fourth  day  the  soreness  of  the  throat  goes  off; 
about  the  sixth  day  the  redness  of  the  skin  begins 
to  retreat;  and,  if  all  things  go  on  well,  the  dis- 
temper abates  very  fast  after  the  seventh  day. 

In  some  of  these  fevers  the  whole  skin  is  co- 
loured, in  others  only  the  breast  and  arms ;  and 
it  is  not  uncommon  to  see  the  redness  only  on  the 
back  of  the  wrist.  This  scarlet  colour  is  either 
equably  diffused  over  the  whole  skin,  without  any 
spots  or  small  pimples,  or  is  deeper  coloured  in 
some  places,  and  lighter  in  others  ;  or  it  is  attend- 
ed with  little  swellings,  like  the  stinging  of  net- 
tles ;  or  else  with  very  small  eruptions,  like  the 
measles.  After  the  redness  has  disappeared,  the 
whole  skin  is  often  renewed,  the  old  one  either 
peeling  off  in  large  pieces,  or  becoming  rough  and 
branny,  and  so  falhng  off.  The  redness  of  the 
skin  affords  no  certain  mark  of  the  degree  and 
event  of  the  disorder ;  I  have  seen  it  become  much 
more  florid  without  any  relief  to  the  patient,  and 
grow  pale  without  any  ill  consequence:  the  warmth 
of  the  bed  is  so  far  from  being  always  the  certain 
means  of  making  the  eruption  more  florid  and  vi- 
gorous, that  I  remarked  it  in  one  patient  to  have 
been  constantly  faint  and  languid  while  she  was 
in  bed,  and  to  have  a  far  livelier  hue  as  long  as 
she  was  up. 

The  eruption  is  often  attended  with  a  very 
troublesome  itching.  It  sometimes  resembles  the 
measles  so  exactly  as  not  to  be  easily  distinguish- 
ed from  the  measley  efllorescence ;  though  this 


History  ami  Cure  of  Diseases,         17 

be  a  mattor  of  great  importance,  because  the 
method  of  cure  in  these  two  distempers  is  ex- 
tremely different.  The  redness  of  the  scarlet  fe- 
ver is  more  equally  diffused  than  in  the  measles, 
and  is  not  in  distinct  spots  with  the  natural  colour 
of  the  skin  interposed  ;  yet,  in  some  few  cases,  I 
have  seen  it  so.  Then  in  the  measles  the  erup- 
tion rises  more  above  the  skin,  and  occasions  a 
manifest  roughness  to  the  touch,  which  is  hardly 
observable  in  the  scarlet  (e\ev^  except  a  very  lit- 
tle roughness  sometimes  in  the  arms.  In  the  scar- 
let fever  there  is  no  cough,  the  eyes  do  not  water, 
and  the  eye-lids  are  not  red  and  swoln ;  all  which 
rarely  fail  to  attend  the  measles.  The  time  like- 
wise of  the  eruption  is  different;  for  it  appears  ia 
the  scarlet  fever  both  in  the  face  and  arms  on  the 
first  or  second  day  ;  but  in  the  measles  it  begins 
only  on  the  third  day  of  the  fever  to  be  visible 
about  the  chin,  and  does  not  come  to  the  arms  and 
hands  till  the  fourth  or  fifth  day. 

Beside  the  restlessness  and  languor,  which  are 
very  great  in  the  scarlet  fever,  several  who  have 
it  in  a  great  degree  are  troubled  with  a  sharp  hu- 
mour in  their  throats  and  nostrils,  which  makes 
them  deaf,  and  hoarse,  and  even  dumb,  and  takes 
away  their  senses  of  tasting  and  smelling.  The 
inside  of  the  nostrils  and  all  the  upper  lip  has 
been  so  corroded  with  this  humour  as  to  leave 
these  parts  sore  and  scabbed  for  a  long  time  after 
the  ceasing  of  the  fever. 

This  distemper  is  not  often  fatal ;  and  is  some- 
times so  very  slight  as  to  last  hardly  a  day,  and 
would  be  utterly  unnoticed,  if,  together  with  oth- 

3 


18  Commentaries  on  the 

er  very  gentle  symptoms,  there  were  not  some 
blush  of  redness  perceivable  in  the  skin,  and  if  at 
the  same  time  others  of  the  family  were  not  ill  of 
this  fever  in  a  more  violent  manner,  so  as  to  leave 
no  room  to  doubt  about  its  nature. 

There  is  no  other  distemper  in  which  a  deli- 
rium is  of  so  little  importance  as  in  this;  in  other 
fevers  it  seldom  comes  on  till  they  have  arrived  at 
a  dangerous  height;  but  it  sometimes  accompa- 
nies a  scarlet  fever  on  the  very  first  day;  and 
many  of  these  patients  never  fail  to  be  light-head- 
ed every  night,  though,  except  this,  there  be  not 
any  unfavourable  symptom  from  the  beginning  to 
the  end  of  their  illness. 

The  small  pox  is  not  more  infectious  than  this 
malady  among  children  and  very  young  persons 
of  both  sexes.  After  their  twentieth  year,  men 
are  very  little  liable  to  catch  it,  though  I  have 
seen  one  man  in  it  who  was  four-and-thirty ;  but 
I  have  not  unfrequently  known  not  only  the  mid- 
dle-aged, but  even  elderly  women  ill  of  this  dis- 
temper: however,  the  older  they  are,  the  more 
secure  they  are  found  to  be  from  its  contagion. 

This  fever  has  begun  to  show  itself  on  the  fifth 
day  after  the  infection  was,  most  probably,  taken 
by  those  who,  being  perfectly  well  before,  have 
been  brought  to  the  house  where  some  children 
where  ill  of  it;  and  perhaps  the  space  of  time  in- 
tervening between  the  infection  and  sickening 
may  here,  as  well  as  in  the  small  pox,  be  general- 
ly nearly  the  same. 


History  and  Cure  of  Diseases.  19 

Where  the  scarlet  fever  proves  fatal,  a  coma 
will  sometimes  show  itself  about  the  fifth  or  sixth 
day,  or  a  shortness  of  breath  with  spitting  of 
blood,  in  those  whose  lungs  appeared  before  to 
be  sound.  Some  few  are  attacked  with  such  vio- 
lence as  to  die  within  the  first  three  dajs. 

After  the  fever  is  much  abated,  and  all  danger 
is  past,  the  glands  under  the  ears  will  sometimes 
swell  with  considerable  pain,  and  even  come  to 
suppuration,  and  in  some  the  testicles  have  swell- 
ed :  the  limbs  will  also  be  afflicted  with  rheumatic 
pains. 

In  the  fever  which  has  just  been  described, 
there  is  always  some  degree  of  redness  in  the  skin, 
and  the  throat  is  not  without  an  uneasy  sensation. 
Where  it  happens  that  the  throat  is  full  of  little 
ulcers  attended  with  considerable  pain,  there  the 
disease,  though  the  skin  be  ever  so  red,  is  not  de- 
nominated from  this  colour,  but  from  the  soreness 
of  the  throat,  and  obtains  the  name  of  the  malig- 
nant sore  throat ;  and  many  suppose  that  the  two 
disorders  differ  in  nature  as  well  as  in  name  :  of 
this  let  the  reader  judge,  when  he  has  considered 
the  histories  of  both. 

§  2.   The  Malignant  Sore  Throat. 

It  is  matter  of  doubt  whether,  in  some  instances 
of  the  malignant  sore  throat,  the  fever,  or  the  aph- 
thous ulcers,  come  first.  For  it  is  observable, 
that  on  the  very  first  day  of  the  fever,  the  fauces 
will  sometimes  appear  so  much  loaded  with  them, 
as  to  make  it  improbable  that  they  should  all  have 
come  on  and  arrived  at  the  state  in  which  they 


to  Commentaries  on  the 

appear  within  the  space  of  one  day.  It  is  by  no 
means  unlikely  that  the  patients  should  pay  very 
little  attention  to  these  small  sores;  for  they  seem 
to  occasion  very  little  pain,  far  less  than  what  is 
felt  in  a  xevy  slight  inflammatory  sore  throat;  and 
there  is  either  no  diflniculty  of  swallowing,  or,  how- 
ever, much  less  than  one  would  imagine  by  seeing 
the  condition  of  the  throat.  In  the  places  where 
the  ulcers  are  about  to  appear,  the  cuticle  becomes 
"whiter  or  ash-coloured;  and  when  it  is  either  rub- 
bed off,  or  cracks  of  itself,  a  small  ulcer  is  disco- 
vered without  any  pus.  Not  only  as  much  of  the 
fauces  as  can  be  seen,  but  the  inside  likewise  of 
the  nostrils,  seems  to  be  the  seat  of  these  ulcers. 
All  these  parts  will  be  swelled  when  the  sores  are 
numerous,  deep,  and  sordid ;  whence  the  patient 
becomes  hoarse,  and  almost  dumb.  The  exter- 
nal part  of  the  throat,  and  the  whole  face,  will 
also  be  sometimes  swelled. 

1  have  seen  the  whole  skin  intensely  red  on  the 
very  first  day  of  the  distemper ;  at  other  times 
only  the  breast  and  arms  have  had  this  colour; 
in  some  patients  it  has  not  been  observable  until 
the  fourth  day  of  the  fever,  and  in  many  it  is 
scarcely  or  never  perceived  at  all.  Where  this 
redness  was  the  most  florid,  the  patients  have  not 
seemed  at  all  the  better ;  nor  have  they  been 
apparently  hurt  when  it  has  faded  and  disappear- 
ed. 

Some  judgment  may  be  formed  of  the  danger 
of  the  fever  from  the  appearance  of  the  aphthae ; 
for  that  will  be  greater  in  proportion  as  these 
occupy  a  larger  space,  and  are  deeper  and  more 


History  and  Cure  of  Diseases.         %i 

firmly  fixed,  and  oftener  grow  again,  and  are  of  a 
more  gangrenous  hue.  But  the  condition  of  these 
sores,  though  it  be  an  index,  yet  is  by  no  means 
the  cause?  of  the  danger :  for  the  enfeebled  and 
disordered  state  of  all  the  functions  of  the  body, 
evidently  points  out  such  a  malignity  of  the  fever, 
as  cannot  be  owing  to  the  affection  of  the  uvula, 
or  tonsils,  which  in  other  distempers  we  often  see 
ulcered,  and  eaten  away,  without  any  danger  of 
the  patient's  life.  These  sores,  therefoje,  like 
pestilential  buboes,  point  out  the  nature  of  the 
disorder ;  but  the  danger  arises  not  from  them, 
but  from  the  fever. 

This  distemper  is  sometimes  so  slight  as  to  re- 
quire no  remedies,  and  sometimes  so  violent  as  to 
admit  of  no  relief  Several  become  light-headed 
on  the  second  day  of  the  fever,  or  comatose, 
breathing  with  great  difficulty,  and  bending  back 
their  heads  as  far  as  they  can ;  a  purulent  and  of- 
fensive mucus  flows  from  their  nostrils,  their 
throats  appear  gangrenous,  and  these  symptoms 
are  soon  followed  by  death  ;  while  others,  after 
having  shown  some  little  appearances  of  this  dis- 
temper for  a  day  or  two,  recover  without  any  as- 
sistance. But  most  of  those  who  are  afflicted 
with  this  fever,  are  very  ill  for  six  or  seven  days 
before  they  sh^  any  signs  of  amendment.  While 
it  continues,  a  remarkable  flow  of  saliva  often 
runs  out  of  their  mouths. 

The  languor,  feebleness,  and  inquietude,  are 
greater  than  might  be  expected  from  the  apparent 
degree  of  fever.  Where  it  proves  fatal,  the 
anxiety  increases,  and  together  with  the  coma. 


SS  Commentaries  on  the 

difficulty  of  breathing,  and  offensive  mucus  before 
mentioned,  there  is  also  an  averseness  from  taking 
every  kind  of  nourishment  or  drink.  This  hap- 
pens not  because  they  are  unable  to  sv^allow,  for 
I  have  often  wondered  to  see  how  readily  they 
could  do  this  when  they  would  try,  though  the 
fauces  seemed  full  of  sordid  ulcers,  and  their 
breath  could  hardly  be  fetched.  The  trachea  in- 
deed seems  to  be  the  seat  of  these  ulcers,  rather 
than  the  oesophagus. 

Among  the  rarer  symptoms  may  be  reckoned 
a  profuse  bleeding  of  the  nose.  1  have  likewise 
observed  this  disease  to  have  been  succeeded  by 
rheumatic  pains,  and  swellings.  Some  persons, 
though  this  very  rarely  happens,  have  been  in- 
fected with  it  more  than  once. 

The  malignant  sore  throat  may  justly  be  called 
the  distemper  of  childhood  and  youth  in  males. 
Among  many  patients  whom  I  have  seen  in  this 
fever,  I  do  not  remember  above  two  or  three 
males  who  were  past  twenty,  and  only  one  who 
was  more  than  thirty.  Women  are  never  entire- 
ly secure  from  it  at  any  age,  though  the  older 
they  are,  they  are  found  to  be  the  less  apt  to  take 
the  infection.  The  younger  the  patients  are,  the 
greater  is  their  danger ;  which  is  contrary  to  what 
happens  in  the  measles  and  small  pox.  In  a  child 
who  died  on  the  sixth  day  of  this  distemper,  and 
was  opened,  the  velum  pendulum  was  putrid ;  the 
tonsils  were  outwardly  blackish,  and  livid  within; 
the  uvula  was  covered  with  a  thick  mucus  resem- 
bling a  membrane  ;  the  epiglottis  was  sound,  and 
so  was  the  oesophagus ;  but  that  mucous  covering 


History  and  Cure  of  Diseases,       S3 

descended  down  the  trachea  quite  to  its  division, 
in  the  upper  part  of  which  it  appeared  hke  a 
membrane,  in  the  lower  part  it  was  more  hke 
mucus. 

From  the  foregoing  description  of  the  scarlet 
fever  and  malignant  sore  throat,  it  seems  highly 
probable  that  they  are  both  names  of  the  same 
distemper,  with  some  little  variety  in  a  few  of  the 
symptoms ;  and  this  opinion  is  confirmed  by  our 
finding  that  they  are  both  epidemical  at  the  same 
time.  Even  in  the  same  family,  where  a  number 
of  children  have  been  ill  either  together,  or  imme- 
diately after  one  another,  some  have  had  the  dis- 
tinguishing symptoms  of  the  scarlet  fever,  and 
others  of  the  malignant  sore  throat.  But  the  so- 
lution of  this  question  is  of  very  little  importance; 
for,  let  the  distempers  be  ever  so  ditferent,  the 
method  of  cure  in  both  is  exactly  the  same,  except 
only  what  may  be  thought  necessary  to  be  appli- 
ed to  the  ulcers  of  the  throat. 

There  may  be  more  use  in  determining,  whe- 
ther this  fever,  like  the  small  pox,  be  incapable  of 
infecting  the  same  persons  more  than  once.  Ac- 
cording to  my  experience,  some  children  have  be- 
yond all  doubt  been  afflicted  a  second  time  with 
this  disease  :  but  it  is  evident  that  this  happens 
very  seldom  ;  for  otherwise,  in  such  a  common 
distemper,  there  could  be  no  more  question  about 
the  possibility  of  a  second  infection,  than  there  is 
in  the  itch,  or  in  venereal  disorders.  1  have  met 
with  several  grown  persons  who  have  had  fre- 
quent returns  of  a  slight  sore  throat,  which  at 
these  times  was  beset  with  little  ulcers  similar  to 


34  Commentaries  on  the 

those  of  the  malignant  sore  throat,  but  without 
any,  or,  at  most  without  much  {ever,  and  without 
any  discolouring  of  the  skin.  If  this  slight  angina 
bear  any  relation  to  the  malignant  one,  it  is  not 
more  than  subsists  between  the  small  pox  and 
those  eruptions  which  are  sometimes  observable 
in  such  as  have  already  had  that  disease,  while 
they  are  nursing  and  attending  others  who  are  ill 
of  it. 

The  very  different  nature  of  the  malignant 
from  that  of  the  inflammatory  sore  throat,  together 
with  the  tender  age  and  weak  habit  of  those  who 
are  most  subject  to  it,  have  made  physicians  at 
present  very  generally  agree  to  condemn  bleeding, 
as  what  would  be  useless  at  best,  and  often  hurt- 
ful to  such  patients.  Yet  in  some  few  persons, 
whose  strength  seemed  able  to  bear  it,  and  whose 
heat,  and  head-ach,  and  manner  of  living,  seemed 
to  require  it,  I  have  known  blood  taken  away 
once,  and  even  twice,  in  the  beginning  of  the  dis- 
temper, with  safety,  and  perhaps  with  advantage. 
All  purging  medicines  should  be  avoided  till  to- 
wards the  end  of  the  fever ;  and  if  a  spontaneous 
diarrhoea  come  on,  it  should  be  checked  as  soon 
as  possible.  Blisters  are  peculiarly  serviceable, 
and  the  patient  should  never  be  without  one,  or 
more,  until  he  be  out  of  danger.  Decoctions,  or 
infusions  of  the  Peruvian  bark  joined  with  aro- 
matics,  appear  to  be  the  most  useful  medicines; 
and  equal  parts  of  a  decoction  of  the  bark  and  of 
the  pectoral  decoction  make  a  very  good  gargle. 
This  gargle  may  be  injected  with  a  syringe  into 
the  throats  of  children  :  but  this  should  by  no 
means  be  done  so  often  as  to  tease  or  fatigue 


History  and  Cure  of  Biseases.        S5 

them  ;  for  the  advantage  of  doing  this  does  not 
seem  to  me  to  be  very  great  above  that  of  getting 
them  frequently  to  wash  their  throats  by  drinking 
either  this,  or  some  more  grateful  liquor.  Simi- 
lar reasons  would  forbid  us  still  more  strongly,  to 
take  great  pains  in  rubbing  off  the  sloughs  from 
these  ulcers,  or  in  scarifying  them.  Besides,  in 
dangerous  cases,  the  trachea  and  the  nostrils  are 
equally  the  seat  of  these  foul  ulcers,  to  the  first 
of  which  nothing  can  be  applied  ;  and  if  the  noses 
of  children  were  to  be  syringed,  they  would  swal- 
low whatever  was  washed  from  the  nose  into  the 
stomach,  where  it  would  not  improbably  do  more 
mischief,  than  in  the  place  from  which  it  had  been 
removed.  My  only  reason  for  suspecting  that  I 
ought  to  lay  more  stress  upon  applications  made 
immediately  to  the  throat,  than  I  have  here  done, 
is,  that  several  physicians  of  deservedly  great  au- 
thority, have  judged  them  to  be  of  more  impor- 
tance than  they  have  appeared  to  me. 


CHAPTER    8. 

jjphthce. 

Aphthae  are  found  chiefly  in  children,  and  old 
persons,  and  in  tedious  fevers.  They  are  usual- 
ly accompanied  with  a  soreness  of  the  throat, 
some  difficulty  of  swallowing,  and  apparently  of 
bringing  up  phlegm,  (for  which  they  mistake  the 
aphthae,)  a  hoarseness,  and  hiccup.  The  Peruvian 
bark  is  given  safely  in  aphthous  fevers,  and  per- 
haps advantageously. 
4 


S6  Commentaries  on  the 

Besides  the  aphthae  which  accompany  acute 
fevers  in  weak  constitutions,  there  are  some  which 
may  be  called  chronical :  these  will  sometimes  be 
very  troublesome  to  the  mouth,  not  only  for 
months,  but  even  years,  without  fever,  or  any 
other  considerable  complaint.  Such  aphthae  have 
continued  for  three  years  after  a  slight  palsy  of 
the  face.  The  West-Indians  sometimes  bring  this 
disorder  with  them  into  England ;  and  they  have 
told  me  that  it  is  a  very  common  one  in  those 
islands,  and  sometimes  ends  in  a  fatal  diarrhoea, 
or  dysentery.  The  aphthae  are  supposed  not  only 
to  infest  the  mouth  and  fauces,  but  to  be  continu- 
ed down  through  the  whole  intestinal  canal.  In 
two  who  died  of  a  lingering  fever,  and  whose 
mouth  was  covered  with  aphthae,  which  hung  in 
rags  all  over  it,  there  was  not  the  least  trace  of 
them  that  could  be  found  in  dissection  beyond  the 
fauces. 


CHAPTER  9, 

Arthritis, 

The  gout  most  usually  begins  with  a  pain  in 
the  first  joint  of  the  great  toe,  which  soon  looks 
very  red,  and  after  a  little  while  begins  to  swell. 
The  violence  of  the  first  pain  seldom  lasts  twenty- 
four  hours ;  but  before  it  has  quite  ceased,  another 
begins  in  the  same,  or  some  other  part,  where  it 
continues  as  long.  A  succession  of  similar  pains 
makes  up  a  whole  fit  of  the  gout.  These  will  be 
renewed  every  day,  or  with  intervals  of  two,  three, 


History  and  6ure  of  Diseases.        S7 

or  more  days,  for  a  few  days,  or  several  weeks. 
And  even  after  there  has  been  such  a  long  cessation, 
that  the  uses  of  the  lirabs  were  ahnost  recovered, 
and  the  swellings  much  abated,  fresh  accesses  of 
pain  have  come  on,  and  visited  all  their  former 
seats,  bringing  back  the  lameness,  and  swellings, 
which  the  patient  had  hoped  were  for  this  time 
ended.  It  sometimes  happens  that  a  gouty  pain, 
which  was  slight  in  the  beginning,  will  continue  to 
increase  for  several  days. 

The  first  fit  seldom  lasts  above  a  week,  or  ten 
days  :  during  the  whole  of  it,  and  commonly  of 
the  two  or  three  succeeding  ones,  no  pain  is  felt 
any  where,  except  in  the  place  where  it  began. 
Afterwards  various  parts  of  the  feet,  the  knees, 
or  hands  will  suffer  before  the  fit  ceases;  and  in 
process  of  time  there  will  scarcely  be  any  part  of 
the  body  secure  from  its  fury.  The  greatest  tor- 
ment is  usually  felt  after  the  first  sleep.  Has  the 
gout  therefore  any  relation  to  those,  complaints 
which  have  been  styled  nervous,  and  which  are  re- 
markably worse  at  this  time  ?  However,  in  some 
the  raging  is  greater  in  the  day-time,  than  at 
night.  There  will  at  first  be  an  interval  of  two  or 
three  years,  or  more,  between  the  fits;  but  after 
some  time  they  will  be  repeated  once  or  twice 
every  year.  The  attacks  of  an  old  gout  are  less 
painful,  but  of  longer  continuance,  and  are  attend- 
ed with  a  greater  and  more  lasting  weakness. 
Most  gouts  continue  to  return  to  the  end  of  life. 
I  never  knew  a  certain  instance  of  their  beginning 
before  the  years  of  puberty. 

Though  the  toe  be  the  usual  place  in  which  a 
regular  gout  first  fixes  itself,  yet  it  will  not  very 


S8  Commentaries  on  the 

unfrequentlj  prefer  the  instep,  the  heel,  or  the 
ande:  but  if  the  first  attack  be  felt  in  any  other 
part  besides  these,  the  continuance  of  such  a  pain, 
the  returns  of  it,  and  its  consequences,  will  differ 
so  much  from  those  of  the  ordinary  gout,  that  it 
is  either  to  be  called  a  rheumatism,  or  should  be 
distinguished  by  some  peculiar  name  from  both 
these  distempers.  For,  besides  those  cases  which 
no  one  would  scruple  to  call  rheumatic,  similar 
pains  have  been  found  to  come  on,  and  have  not 
only,  like  the  common  rheumatism,  continued  for 
two  or  three  months  attacking  by  turns  all  the 
limbs;  but  have  in  their  first  year  returned  two 
or  three  times,  and  have  continued  to  do  so  for 
some  succeeding  years.  These  pains  are  less  vio- 
lent than  in  the  common  gout,  though  the  swel- 
lings are  much  greater:  but  the  remarkable  cir- 
cumstance is  the  great  and  lasting  feebleness 
which  they  occasion;  so  that  the  limbs  have  been 
more  weakened  by  them  in  two  years,  than  they 
usually  are  even  by  severe  fits  of  the  regular  gout 
in  twenty.  The  late  Dr  Oliver  of  Bath  told  me, 
that  he  considered  this  disorder  as  partaking  of 
the  nature  both  of  the  rheumatism  and  palsy.  In 
the  cases  which  1  have  observed  of  this  malady, 
whatever  it  be  named,  when  the  pain  does  not 
fi^rst  attack  the  foot,  and  when  its  returns  are  so 
frequent,  it  has  more  usually  come  on  after  the 
sixtieth  year,  than  before  that  age :  yet  there  have 
been  instances  where  young  men  have  been  made 
cripples   by  it  long  before   they   were   thirty.* 

The  gout  is  derived  from  gouty  ancestors,  or  is 
created  by  intemperance,  or  arises  from  some  un° 

*  See  chap.  79,  on  the  Rheumatism  - 


History  and  Cure  of  Diseases,       29 

known  causes,  which  are  sometimes  found  in  the 
sober  and  abstemious,  none  of  whose  family  had 
previously  been  afflicted  with  this  distemper. 
Women  are  less  subject  to  it  than  men;  yet  ex- 
amples of  gouty  women  are  by  no  means  rare  :  it 
has  even  spared  all  the  children  of  gouty  parents 
except  one  of  the  daughters ;  and  1  have  known 
a  female  who  suffered  by  the  gout  to  the  degree 
of  having  numerous  sores  from  chalkstones,  though 
it  had  never  been  heard  of  among  any  of  her  re- 
lations. 

Violent  fits  frequently  repeated,  usually  pro- 
duce chalkstones  and  chalky  sores,  and  by  these, 
or  in  consequence  of  numerous  inflammations,  make 
the  joints  stiff  and  almost  useless.  The  cramp 
may  also  be  reckoned  one  of  the  certain  attend- 
ants upon  the  gout.  Flatulencies,  heartburn,  in- 
digestion, loss  of  appetite,  sickness,  vomiting, 
acidities,  with  pains  of  the  stomach  and  bowels, 
giddiness,  confusion  and  noises  in  the  head,  numb- 
ness of  the  limbs,  epilepsies,  palsies,  apoplexies, 
inquietude,  universal  aches,  wastings  of  the  flesh 
and  strength  and  lowness  of  spirits,  are  symp- 
toms, some  of  which  often  attend  the  fit,  and  some 
follow  it ;  and  most  of  them  are  the  lot  of  old 
gouty  patients,  who  have  moreover  the  prospect 
of  entailing  all  these  upon  their  posterity. 

Though  at  first  the  gout  return  but  rarely,  yet 
at  length  it  becomes  familiar,  returning  oftener, 
and  staying  longer,  and  by  the  uncertainty  of  the 
fits  interrupting  all  business,  and  disappointing  all 
pleasures.  During  its  presence  the  patient  is 
helpless  as  an  infant,  and  without  those  circum- 


30  Commentaries  on  the 

stances  which  make  an  infant  so  easily  and  cheer- 
fully assisted.  It  can  hardly  be  reckoned  one  of  ' 
the  disadvantages  of  the  gout,  that  after  destroy- 
ing all  the  comforts  of  living,  by  this  weight  of 
misery,  or  by  bringing  on  a  palsy  or  apoplexy, 
it  immaturely  extinguishes  the  powers  of  life. 
Yet  people  are  neither  ashamed,  nor  afraid  of  it; 
but  are  rather  ambitious  of  supposing  that  every 
complaint  arises  from  a  gouty  cause,  and  support 
themselves  with  the  hopes  that  they  shall  one 
day  have  the  gout,  and  use  variety  of  means  for 
this  purpose,  which  happily  for  them  are  gene- 
rally ineffectual. 

Various  distempers  in  certain  ages  and  coun^ 
tries  have  had  the  fashion  on  their  side,  and  have 
been  thought  reputable  and  desirable  :  others,  on 
the  contrary,  have  been  reckoned  scandalous  and 
dreadful ;  not  from  any  circumstance  belonging  to 
the  distemoers  themselves,  or  to  the  manner  in 
which  they  are  contracted,  but  from  some  preju- 
dice or  fancy  not  easily  to  be  accounted  for. 
Epilepsies  seem  to  have  been  held  in  particular 
abomination  by  the  ancient  Romans ;  and  ruptures 
both  with  them  and  with  the  moderns,  have  been 
attended  with  as  unmerited  a  shame.  Some 
maladies  have  been  esteemed  honourable,  be- 
cause they  have  accidently  attacked  the  great,  or 
because  they  usually  belong  to  the  wealthy,  who 
live  in  plenty  and  ease.  We  have  all  heard  of 
the  courtiers  who  mimicked  the  wry  neck  of  Alex- 
ander the  Great ;  and  when  Lewis  XIV.  happened 
to  have  a  fistula,  the  French  Surgeons  of  that 
time  complain  of  their  being  incessantly  teased 
by  people,  who  pretended,  whatever  their  com- 


History  and  Cure  of  Diseases,         31 

plaints  were,  that  they  proceeded  from  a  fistula : 
and  if  there  bad  been  in  France  a  mineral  water 
reputed  capable  of  giving  it  them,  they  would 
perhaps  have  flocked  thither  as  eagerly  as  En- 
glishmen resort  to  Bath  in  order  to  get  the  gout. 
For  this  seems  to  be  the  favourite  disease  of  the 
present  age  in  England ;  wished  for  by  those  who 
have  it  not,  arid  boasted  of  by  those  who  fancy 
they  have  it,  though  very  sincerely  lamented  by 
most  who  in  reality  suffer  its  tyranny.  Hence, 
by  a  peculiar  fate,  more  pains  seem  to  be  taken 
at  present  to  breed  or  produce  the  gout,  than  to 
find  out  its  remedy.  For,  so  much  respect  hath 
been  shown  to  this  distemper,  that  all  the  other 
ails,  except  pain,  which  the  real  or  supposed  gouty 
patient  ever  feels,  are  imputed  most  commonly 
not  to  his  having  had  too  much  of  this  disease,  but 
to  his  wanting  more ;  and  the  gout,  far  from  being 
blamed  as  the  cause,  is  looked  up  to  as  the  ex- 
pected deliverer  from  these  evils 

The  love  of  life,  or  fear  of  death,  makes  most 
men  unwilling  to  allow  that  their  constitution  is 
breaking;  and  for  this  reason  they  are  ready  to 
impute  to  any  other  cause  wliat  in  reality  are  the 
signs  of  approaching  and  unavoidable  decay. 
Hence,  in  a  beginning  failure  or  languidness  of  the 
functions  of  lite,  they  easily  persuade  themselves 
that  their  complaints  are  all  owing  to  a  lurking 
gout,  and  that  nothing  j*s  wanted  but  a  just  fit,  to 
the  re-establishment  of  their  health.  Now,  to 
say  nothing  of  the  slight  grounds  upon  which 
these  fond  hopes  of  a  latent  gout  are  generally 
founded,  is  it  as  certainly  true  as  it  is  commonly 
believed,  that  this  distemper,  when  it  comes  to  a 


S2  Commentaries  on  the 

strong  fit,  clears  the  constitution  from  all  others ; 
and  that  bj  creating  or  exciting  it,  we  should  not 
superadd  one  more  evil  to  those  which  were  suf- 
fered before  ?  The  itch  is  supposed  to  be  whole- 
some in  some  countries,  where  it  is  endemial ;  and 
ague  has  been  considered  as  a  minister  of  health, 
whose  presence  and  stay  ought  by  all  means  to 
be  courted.  These  opinions  are  now  pretty 
generally  exploded  in  England  ;  and  I  hope  the 
time  will  come,  when  a  specific  for  the  gout,  as 
certain  as  those  which  have  been  discovered  for 
these  two  disorders,  will  ascertain  the  equal  safety 
and  advantage  of  immediately  stopping  its  career 
and  preventing  its  returns. 

If  w-e  ask  what  reason  there  is  to  consider  the 
gout  as  a  critical  discharge  of  peccant  humours, 
more  than  a  rheumatism,  palsy,  or  epilepsy,  we 
can  only  be  referred  to  experience  for  the  proof; 
and  some  indeed  in  the  first  attack  of  the  gout 
congratulate  themselves  upon  the  completion  of 
their  wishes,  and  during  the  honey-moon  of  the 
first  fit,  dreaming  of  nothing  but  perfect  health 
and  happiness,  persuade  themselves  that  they 
are  much  the  better  for  it;  for  new  medicines, 
and  new  methods  of  cure,  always  work  miracles 
for  a  while.  Of  such  we  must  not  inquire,  but  of 
those  who  have  had  it  their  companion  for  a  great 
part  of  their  lives.  Now,  among  those  gouts  which 
I  have  had  opportunity  of  seeing,  I  find  by  the  notes 
which  1  have  taken,  that  the  patients,  in  whom 
they  have  supervened  other  distempers  without 
relieving  them,  or  where  they  have  been  thought 
to  bring  on  new  disorders,  are  at  least  double  in 
number  to  those  in  whom  they  have  been  judged 


Hislory  and  Cure  of  Diseases,       33 

to  befriend  the  constitution  ;  and  it  has  appeared 
to  nie,  that  the  mischief  which  has  been  laid  to 
their  charge,  was  much  more  certainly  owing  to 
them,  than  the  good  which  they  had  the  credit  of 
doing.  Other  disorders  will  indeed  sometimes  be 
suspended  upon  an  attack  of  the  gout ;  and  so 
they  will  by  palsies,  fevers,  asthmas,  small  pox, 
and  madness,  of  which  I  have  seen  many  instan- 
ces ;  but  then  the  gout  has  often  come  on  when 
persons  were  labouring  under  vertigos,  shortness 
of  breath,  loss  of  appetite,  and  dejection  of  spirits, 
without  affording  the  least  relief,  and  sometimes 
it  has  manifestly  aggravated  them ;  nay,  these 
complaints  have  in  some  patients  always  come  on 
with  the  gout,  and  have  constantly  attended  it 
during  ihe  whole  fit. 

If  the  gout  return  but  seldom,  and  its  stay  be 
but  short,  the  patient  may  be  very  little  the  worse 
for  it;  just  as  he  might  have  had  an  epileptic  fit 
once  in  a  3'ear,  and  yet  might  die  in  a  good  old 
age.  However,  the  health,  as  1  have  observed, 
will  sometimes  begin  to  decline  even  from  the 
first  fit,  and  gradually  sink  from  that  time  under 
the  usual  signs  of  an  irreparably  shattered  consti- 
tution ;  where,  though  there  might  be  some  doubt 
whether  the  gout  occasioned  the  mischief,  yet 
there  could  be  none  that  it  did  not  prevent  it. 

In  an  old  gout,  as  was  before  observed,  much 
of  that  intenseness  of  pain  is  abated  which  accom- 
panied the  early  fits  ;  and  this  may  have  given 
occasion  to  the  opinion,  that  those  complaints 
which  were  truly  owing  to  age  or  other  distem- 
pers, or  perhaps  to  repeated  fits  of  the  gout  itseif, 

5 


34  Commentaries  on  th& 

were  to  be  imputed  to  the  want  of  more  pain,  and 
of  stronger  fits.  I  remember  a  person  who  for 
fifteen  years  had  every  year  a  return  of  gout ;  and 
during  all  this  time  he  was  troubled  with  an  asth- 
ma :  at  length  the  health  became  ruined,  and  his 
constitution  utterly  broken ;  and  it  was  remarka- 
ble that  during  the  hve  years  in  which  he  con- 
tinued languishing  before  he  died,  he  suffered 
neither  gout  nor  asthma.  Now  no  one  would  sup- 
pose, that  in  this  case  the  ill  health  was  at  all  ow- 
ing to  the  want  of  an  asthma ;  and  what  better 
reason  was  there  to  believe  that  it  was  owing  to 
a  want  of  the  gout  ?  The  violence  of  the  fits  is  so 
far  from  being  useful  to  the  health,  that  to  this 
circumstance,  and  the  frequency  of  them,  must  be 
imputed  the  quicker  progress  which  they  make  in 
rendering  the  limbs  of  some  patients  useless  soon- 
er than  those  of  others,  and  in  bringing  on  those 
other  ails  which  I  suspect  to  be  the  genuine  off- 
spring of  the  gout ;  so  that  some  persons  will  find 
their  health  more  impaired  by  it  in  seven  years, 
than  others  will  in  thirty. 

The  true  arthritic  paroxysm,  after  a  few  visits, 
is  well  known  to  return  in  most  patients  very  re- 
gularly every  year;  but  I  have  seen  those  in  whom 
after  having  returned  yearly  for  ten,  twelve,  four- 
teen, twenty,  and  even  twenty-eight  years,  no  fit 
has  been  felt  for  three  years,  for  ten,  and  twelve, 
and  even  for  thirty  years,  without  any  kind  of 
harm  which  could  be  attributed  to  its  absence* 
Such  cases  teach  us  that  constant  returns  of  the 
gout  are  by  no  means  so  necessary  to  the  health 
of  arthritic  patients  as  has  been  surmised ;  and 
that  they  may  very  well  be  spared^  even  ^fter  hay- 


History  and  0ure  of  Diseases.         35 

ing  so  far  accustomed  the  constitution  to  the  gout, 
that  health  and  life,  according  to  the  vulgar  no- 
tion, could  hardlj  be  carried  on  without  its  sea- 
sonable aid  ;  nor  need  we  therefore  be  so  much 
afraid  of  looking  out  for  and  employing  such  po- 
tent medicines  as  may  be  specific  antidotes  to 
this  peculiar  poison. 

But  let  the  producing  or  maturing  of  a  suppres- 
sed or  unformed  gout  be  ever  so  advantageous, 
still,  all  physicians  must  allow  the  criteria  of  it  to 
be  very  obscure,  and  that  there  are  none  by  which 
we  can  know,  and  I  think  hardly  any  which  give 
us  ground  to  suspect  this  disease,  where  there  is 
no  pain,  nor  redness,  nor  swelling  in  the  first  joint 
of  the  great  toe,  or  in  any  other  part  of  the  foot, 
.and  where  the  person  never  had  the  gout,  nor  has 
any  hereditary  right  to  it.  Yet,  notwithstanding 
the  absence  of  all  these  circumstances,  it  is  not 
uncommon  to  see  it  charged  with  being  the  cause 
of  almost  every  beginning  chronical  disease,  and 
of  some  acute  ones.  An  errour  here  is  often  at- 
tended, among  other  ill  consequences,  with  that 
of  inducing  people  to  drink  a  much  greater  quan- 
tity of  wine,  and  spirits,  than  they  have  ever  been 
accustomed  to,  or  than  they  ought  ever  to  drink; 
so  that  I  have  seen  several  intoxicate  themselves 
with  strong  liquors  for  two  or  three  days  together, 
upon  presumption  that  they  wanted  a  gouty  fit, 
and  that  this  was  a  proper  way  of  procuring  one. 
Now,  a  long  course  of  intemperance  and  debauch- 
ery probably  disposes  a  man  to  breed  this  dread- 
ful disorder;  but  the  drinking  an  immoderate 
quantity  of  inebriating  liquor  is  in  my  judgment 
more  likely  to  oppress,  than  to  assist  the  powers 


36  Commentaries  on  the 

of  nature,  in  struggling  under  the  approaches  even 
of  the  gout ;  and  Tew  will  dispute  this  in  any  oth- 
er illness,  which  may  be,  and  often  is,  mistaken 
for  t*he  gout.  I  have  too  much  reason  to  say,  that 
not  only  the  chronical  disorders  of  carious  bones, 
scirrhous  and  cancerous  tumours  of  the  brain, 
lungs,  and  abdominal  viscera,  but  even  the  acute 
ones  of  peripneumonies,  and  inflammations  of  the 
stomach  and  bowels,  have  been  supposed  arthri- 
tic, and  have  been  accordingly  treated  with  Bath 
waters,  or  with  the  strongest  spices  and  spirituous 
liquors,  till  they  became  utterly  incapable  either 
of  cure  or  palliation  ;  which  treatment  has,  I  fear, 
done  much  less  good  in  the  true  internal  gout, 
than  it  has  done  harm  by  aggravating  the  pains 
and  fever,  where  the  gout  has  been  falsely  sus- 
pected. 

The  gout  is  indeed  a  common  distemper,  but 
not  quite  so  common  as  is  imagined  ;  nor  has  ex- 
perience satisfied  me,  that  in  the  beginning  it  is 
so  very  apt  to  mistake  its  way  to  the  extremities, 
and,  instead  of  them,  to  fix  upon  and  oppress  the 
functions  of  the  brain,  or  lungs  or  stomach,*though 
in  its  advanced  state  this  sometimes  happens. 
Wherever  there  is  a  doubt  whether  the  distemper 
be  gouty,  or  what  is  called  inflammatory  and  re- 
quiring a  cooling  regimen,  there  blisters,  and  oth- 
er remedies  suitable  to  both  these  cases,  should 
be  used  till  the  doubt  can  be  cleared  up  by  a  lit- 
tle delay :  but  if  the  danger  be  too  urgent  to  ad- 
mit of  this,  it  will  be  far  more  hazardous  to  neg- 
lect bleeding  in  an  inflammatory  distemper,  than 
to  take  away  blood  in  the  gout,  which  is  indeed 
discouraged  by  Sydenham ;  nor  do  I  know  that  it 


Mistory  and  Cure  of  Diseases,         37 

is  advisable  ;  but  it  is  not  a  practice  attended  with 
anj  certain  and  constant  clanger.  One  person 
was  bled  by  his  own  direction  in  every  fit  of  the 
gout  for  six-and-thirty  years  ;  and  bleeding  was  a 
frequent  practice  with  another  in  the  agony  of  the 
paroxysm,  which  it  always  abated  so  as  to  bring 
on  a  sound  and  refreshing  sleep  without  any  mani- 
fest ill  etfect.  If  the  lungs  be  strongly  affected, 
bleeding  will  often  be  unavoidable  and  necessary, 
though  we  be  sure  that  it  is  a  gouty  affection.  In 
complaints  of  a  chronical  nature,  whatever  suspi- 
cions there  may  be  of  gout,  it  would  be  no  bad 
rule  of  practice  not  to  direct  the  waters  of  Bath, 
nor  any  other  remedies  which  are  supposed  to 
give  the  gout,  if  they  would  be  iujproper  when 
the  same  complaints  arise  from  otiier  causes ;  but 
to  content  ourselves  with  putting  the  general 
health  into  the  best  state,  by  strengthening  the 
appetite  and  digestion,  and  by  relieving  any  ur- 
gent symptoms. 

I  shall  not  enter  into  an  examination  of  the  effi- 
cacy of  Bath  waters,  and  of  spicy  or  spirituous 
medicines  in  producing  the  gout,  if  this  were  ever 
so  advisable.  Experience  will  soon  convince  any 
one,  that,  if  there  be  any  such  powers,  they  are 
far  overrated.  The  slight  wandering  pains,  which 
may  be  felt  upon  using  these  means,  and  are  call- 
ed gouty  efforts,  are  what  perhaps  may  be  felt  at 
any  time,  if  they  were  as  much  watched  and  at- 
tended to,  in  such  as  have  passed  the  meridian  of 
life. 

The  gout  affords  a  striking  proof  of  the  long 
experience  and  wary  attention  necessary  to  find 


68  Commentaries  on  the 

out  the  nature  of  diseases  and  their  remedies. 
For  though  this  distemper  be  older  than  any  me- 
dical records,  and  in  all  ages  so  common  ;  and  be- 
sides, according  to  Sydenham,  chiefly  attacks  men 
of  sense  and  reflection,  who  would  be  able,  as  well 
as  willing,  to  improve  every  hint  which  reason  or 
accident  might  throw  in  their  way ;  yet  we  are 
still  greatly  in  the  dark  about  its  causes  and  ef- 
fects, and  the  right  method  in  which  it  should  be 
treated.  But  as  the  supposed  hazard  of  curing  it 
is  now  the  general  belief,  it  seems  but  reasonable 
that  it  should  not  be  made  the  opprobrium  of  the 
art  of  healing,  till  the  patients  will  conquer  their 
fears,  and  allow  that  it  ought  to  be  cured.  Hap- 
py, however,  would  it  be  for  mankind,  if  the  diffi- 
culty of  curing  the  gout  were  to  become  as  little 
as  the  danger  of  it. 

The  brain,  and  the  stomach,  with  the  bowels, 
are  great  sufferers  by  this  distemper,  as  well  as 
the  limbs.  Issues  are  a  probable  means  of  secur- 
ing the  brain  from  the  mischievous  effects  of  re- 
peated fits  ;  and  bitters,  and  eccoprotics,  are  the 
proper  remedies  which  reason  would  suggest  for 
the  stomach :  the  utility  of  all  which  means  hath 
been  confirmed  to  me  by  experience. 

Strong  wines,  and  in  no  small  quantity,  have 
the  reputation  of  being  highly  beneficial  to  gouty 
persons  ;  which  notion  they  have  very  readily  and 
generally  received,  not  so  much  perhaps  from  a 
reasonable  persuasion  of  its  truth,  as  from  a  desire 
that  it  should  be  true,  because  they  love  wine. 
Let  them  consider  that  a  free  use  of  vinous  and 
spirituous  liquors  peculiarly  hurts  the  stomach  and 


History  and  Cure  of  Diseases,  39 

organs  of  digestion,  and  that  the  gout  is  bred  and 
fostered  by  those  who  indulge  themselves  in  drink- 
ing much  wine  ;  while  the  poorer  part  of  mankind, 
who  can  get  very  little  stronger  than  water  to 
drink,  have  better  appetites  than  wine-drinkers, 
and  better  digestions,  and  are  far  less  subject  to 
arthritic  complaints.  The  most  perfect  cures  of 
which  I  have  been  a  witness,  have  been  effected 
by  a  total  abstinence  from  spirits,  and  wine,  and 
flesh ;  which  in  two  or  three  instances  hath  restor- 
ed the  helpless  and  miserable  patients  t1rom  a 
state  worse  than  death,  to  active  and  comfortable 
life  :  but  I  have  seen  too  few  examples  of  the  suc- 
cess of  this  method,  to  be  confident  or  satisfied  of 
its  general  utility. 

A  question  may  be  made,  whether  the  patient 
should  yield  to  the  gout  upon  its  first  approach, 
and  indulge  it  with  ease;  or  by  endeavouring  to 
move  and  use  the  gouty  limb,  should  resist  it  as 
long  as  he  is  able.  By  indulgence  the  fit  lasts  the 
longer ;  and  this  is  sometimes  what  the  patient 
wishes,  and  what  the  physician  is  requested  to  ef- 
fect, from  a  notion  that  the  gouty  matter  accumu- 
lates in  some  constitutions,  and  at  certain  periods 
requires  a  discharge,  w^hich  ought  to  be  free  and 
copious,  that  the  unnatural  load  may  be  perfectly 
thrown  off.  On  the  other  side,  some,  more  from 
impatience  than  from  system,  have  employed  all 
the  means  they  could  devise  to  stifle  a  fit  as  soon 
as  its  coming  was  perceived.  The  great  Dr. 
Harvey,  as  I  have  been  told  by  some  of  his  rela- 
tions, upon  the  first  approach  of  gouty  pains  in 
his  foot,  would  instantly  put  them  off  by  plunging 
the  leg  into  a  pail  of  cold  water.     1  have  known 


40  Commentaries  on  the 

several,  who  instead  of  nursing  a  beginning  gout 
with  warmth  and  repose,  have  used  the  utmost 
resolution  and  exertion  in  moving  and  exercising 
the  hmb,  which  they  found  themselves  gradually 
able  to  do  more  and  more,  till  at  last  they  reco- 
vered its  perfect  use,  free  from  any  feelings  of 
pain,  and  without  any  manilest  ill  consequences. 
How  much  may  be  done  by  vigorous  efforts  to 
shake  off  the  gout  we  know  by  many  unques- 
tionable facts.  Arthritic  patients,  who  were  as 
incapable  of  moving  themselves  as  their  malady 
could  make  them,  upon  the  sudden  alarm  of  fire, 
or  other  dangers,  have,  by  an  instantaneous  exer- 
tion, recovered,  and  made  very  good  use  of  their 
limbs. 

I  do  not  recommend  Dr.  Harvey's  example  as 
proper  to  be  imitated,  though  it  is  known  he  liv- 
ed to  a  good  old  age  ;  but  I  am  not  warranted  by 
any  experience  to  condemn  the  practice  of  endea- 
vouring by  exercising  the  limb  to  prevent  the 
gout  from  settling  there.  If  indeed  a  fit  of^the 
gout  be  only  giving  vent  to  matter  which  has 
been  collected  and  ought  to  be  discharged,  how 
comes  it  to  pass  that  the  taking  of  purging  phy- 
sic at  the  end  of  a  regular  fit  will  be  apt  to  bring 
on  a  fresh  fit  ?  which  I  have  reason  to  believe  not 
only  from  my  own  experience,  but  upon  better 
authority  than  my  own.  Similar  effects  have  so 
often  happened  from  an  accidental  hurt  of  a  limb 
by  a  blow  or  strain,  or  even  the  sting  of  a  gnat, 
that  the  hypothesis  of  accumulated  gouty  matter 
can  scarcely  be  allowed  to  be  the  cause  of  every 

fit.       ^ 


Histovy  and  Cure  of  Diseases,        41 

Those   who  choose  to  invite  the  stay  of  the 
gout,  and  are  afraid  of  disturbing  its  repose  by 
any  motions  of  the  affected  hmbs,  often  add  very 
unnecessarily  to  the  difficulty  of  moving  them,  by 
the  quantity  of  flannel  in  which  they  are  wrapped 
up  even   in  the  hottest  weather.     I  never  could 
see  any  reason  for  adding  at  all  to  the  usual  co- 
vering of  the  limb,  unless  its  extraordinary  ten- 
derness,  or  the  severity  of  the   weather,  might 
make  a  very  little  more  necessary  to  keep  off  the 
sensation  of  cold,  so  disagreeable  to  a  part  which 
is  swelled  and  in  pain.     The  waters  of  Bath  are 
reputed  to  possess  specific  virtues  in  gouty  com- 
plaints.    There  seems  to  be  great  confusion,  and 
some    inconsistency,    in    the    prevailing    opinions 
about  these  virtues ;  for  the  existence  of  many  of 
which  it  would  be  difficult  to  allege  any  satisfac- 
tory proofs  from  reason,  or  from  any  experience 
which  has  fallen  within  my  observation.     In  many 
stomach  complaints  they  are  found  very  benefi- 
cial;  and  as  the  stomachs  of  arthritic  persons  are 
exceedingly  subject  to  weakness,  flatulence,  aci- 
dities, and  indigestion,  the  drinking  of  these  wa- 
ters often  proves  a  great  relief  to  them,  both  dur- 
ing the   fits   and  in   the   intervals.     What  other 
powers  their  internal  use  possesses  of  creating  or 
curing  the  gout,  or  of  lessening  any  part  of  its 
misery,  remains  a  matter  of  great  doubt  and  ob- 
scurity.    I  have  not  been  able  to   observe  any 
good   in  arthritic  cases  from  the  external  use  of 
these  waters,  either  when  the  distemper  was  pre- 
sent, or  in  its  absence  :  on  the  contrary,  it  has  ra- 
ther appeared  to  increase  the  weakness  of  the 
limbs  ;  and  sea-bathing  has  contributed  far  more 
to  recovering  the  strength  of  gouty  persons,  many 

6 


4S  Commentaries  on  the 

of  whom,  in  the  intervals  of  their  fits,  have  used 
it  with  safety  and  advantage. 

When  the  gout  is  conjectured  to  have  seized 
the  stomach,  it  has  been  usual  to  endeavour  to 
relieve  the  pain  and  sickness  by  strong  wines, 
and  spirituous  liquors,  poured  down  in  great 
abundance.  According  to  all  my  observation  of 
such  cases,  1  judge  that  opium,  and  hot  spices  af- 
ford more  efficacious  remedies,  and  are  attended 
with  less  inconvenience. 

The  Portland  powder  is  one  of  a  great  crowd 
of  specifics,  of  which  the  rise,  and  reign  and  fall, 
have  all  happened  within  my  memory.  It  rose 
into  favour  too  fast,  and  too  high,  to  keep  its 
place  ;  but  it  appears  to  me  to  have  sunk  into  a 
state  of  discredit  and  neglect,  as  much  below  its 
real  merit,  as  the  first  praises  were  above  it.  Be- 
fore the  Peruvian  bark  was  discovered,  mankind 
had  by  repeated  trials  come  to  confide  in  the  use 
of  those  medicines  which  are  next  akin  to  the 
bark,  and  will  often  very  effectually  cure  an  in- 
termittent fever,  even  sometimes  where  the  bark 
has  failed.  In  other  distempers  we  may  observe 
a  like  gradual  dawning  of  the  just  method  of 
treating  them,  long  before  time  and  experience 
had  advanced  it  so  far  as  to  make  it  generally 
perceived  and  acknowledged.  Nor  is  it  a  small 
ground  of  expectation  from  any  medicines,  that  in 
them  the  experience  of  many  ages,  and  different 
countries,  has  seemed  disposed  to  centre.  This 
in  some  measure  is  the  case  of  the  Portland  pow- 
der, many  of  its  ingredients  being  commended  as 
anti-arthritic  remedies,  by  a  variety  of  writers 


History  and  Cure  of  Diseases.        43 

both  ancient  and  modern  :*  and  the  peculiar  mis- 
chief which  this  distemper  does  to  the  appetite 
and  digestion,  makes  it  probable  that  its  power 
might  be  so  far  curbed  and  counteracted  by  what- 
ever strengthens  the  stomach,  as  to  afford  us 
hopes  of  considerable  relief,  if  not  a  cure. 

The  Portland  powder  lost  its  reputation,  partly 
by  the  largeness  of  the  dose,  which,  though  al- 
most too  great  for  any  one,  was  indiscriminately 
given  to  all,  and  partly  by  having  all  the  natural 
ill  effects  of  the  gout  imputed  to  it,  particularly 
palsies  and  apoplexies ;  to  the  causing  of  which 
diseases  I  judge  the  gout  to  have  of  itself  a  ten- 
dency, because  1  have  several  times  known  them 
succeed  immediately  to  a  regular  and  severe  fit. 
However,  the  virtues  of  this  powder  often  ap- 
peared to  be  such,  as  to  make  it  well  deserve 
some  pains,  in  trying  to  secure  its  good  qualities, 
and  to  correct  its  faults  :  for  during  the  great 
vogue  of  this  medicine,  the  fit  was  so  frequently 
found  to  be  lessened,  or  to  miss  its  usual  time  of 
coming,  after  this  remedy  had  been  taken,  that 
few  can  have  any  doubt,  and  for  my  own  part  I 
have  none,  of  its  having  produced  these  effects ; 
while  its  having  any  share  in  the  mischief  imput- 
ed to  it  is  void  of  any  certain  proof,  or,  in 
my  opinion,  of  much  probability.  Nor  indeed 
was  its  disgrace  owing  to  its  doing  too  little,  but 
to  its  doinof  too  much.  The  dread  of  beinof  cur- 
ed  of  the  gout  was,  and  is  still,  much  greater 
than  the  dread  of  having  it;  and  the  world  seems 

*  See  Medical  Observations  and  Inquiries  by  a  Society  of  lion- 
doo  Physicians,  vol.  i.  art.  14. 


*44«  Cotnmentames  on  the 

agreed  patiently  to  submit  to  this  tyrant,  lest  a 
worse  should  corae  in  its  room. 

If  the  strengthening  of  the  appetite  and  diges- 
tion be  those  etfects  of  the  Portland  powder,  by 
which  it  has  either  shortened  or  prevented  the 
gouty  attacks,  then  it  may  be  much  improved  by 
leaving  out  some  ingredients  not  very  useful  for 
this  purpose,  and,  instead  of  giving  the  same  dose 
to  all,  by  using  great  attention  in  proportioning 
the  strength  and  quantity  so  as  to  make  it  be 
easily  borne  by  the  patient.  It  will  be  absurd  to 
attempt  strengthening  the  stomach  by  such  means 
as  will  not  fail,  either  by  their  load  or  nauseous- 
ness,  to  bring  on  disgust  and  loathing,  which  has 
frequently  happened  in  the  use  of  the  Portland 
powder. 

The  herbs  germander,  ground-pine,  worm- 
wood, carduus  benedictus,  bog-bean  or  bug-bane, 
horehound,  and  the  lesser  centaury,  the  flowers 
of  camomile,  Seville  orange  peel,  the  Peruvian 
bark,  and  the  roots  of  columbo,  and  gentian,  are 
the  principal  stomachic  simples ;  which  perhaps 
exert  their  powers  more  fully  in  powder,  than  in 
an  infusion  or  tincture.  This  variety  affords  us 
scope  for  contriving  a  medicine  tolerable  to  the 
palate,  and  agreeable  to  the  stomach  of*  almost 
every  patient.  It  is  impossible  to  decide,  without 
trial,  which  of  these  would  be  the  best  borne  by 
any  particular  patient ;  and,  lest  any  one  should 
be  peculiarly  disagreeable,  it  will  be  useful  to 
mix  three  or  four  of  them  together,  by  which 
their  general  benefit  may  be  obtained  ;  whilethe 
separate  qualities  of  each,  to  some  of  whichthe 


History  and  Cure  of  Diseases,       45 

patient  might  have  a  dislike,  would  be  too  incon- 
siderable to  occasion  any  inconvenience.  The 
length  of  time  during  which  it  must  be  continued 
is  an  additional  reason  for  carefully  avoiding  eve- 
ry thing  offensive,  either  in  the  quality,  or  dose 
of  the  medicine  ;  at  the  same  time  it  should  be 
made  as  powerful,  and  as  much  should  be  given, 
as  can.  easily  be  borne.  Not  less  than  fifteen 
grains  should  be  directed  twice  a  day,  in  a  little 
simple  peppermint  water  or  common  water ;  and 
few  would  bear  to  take  more  than  two  scruples 
for  a  continuance.  Three  or  four  grains  of  any 
aromatic  most  agreeable  to  the  patient  would  be 
an  useful  addition,  by  assisting  the  stomachic  vir- 
tues of  the  bitter,  and  by  enabling  the  patient  to 
persevere  for  two  years  or  more  in  taking  it ;  as 
the  aromatic  might  be  varied,  and  give  a  new 
taste  to  the  medicine,  as  often  as  any  disgust 
arose. 

Before  I  conclude  this  article,  it  may  not  be 
improper  to  lay  down  the  distinguishing  charac- 
teristics of  what  I  would  call  gout,  and  rheuma- 
tism. 

In  the  former  of  these  disorders,  the  first  attack, 
consisting  perhaps  of  several  ragings  and  remis- 
sions, is  wholly  confined  to  the  first  joint  of  the 
great  toe,  or  however  to  some  part  of  the  foot ; 
and  the  fit  does  not  usually  last  above  ten  days 
or  a  fortnight. 

The  pains  are  sometimes  preceded  either  by  a 
considerable  fever,  or  by  slight  feels  of  illnjess, 
which  for  a  few  days  make  the  sleep  less  sound, 


46  Commentaries  on  the 

or  in  a  small  degree  abate  the  vigour  of  the  ap^ 
petite,  digestion,  spirits,  and  strength. 

The  part  affected  is  coloured  with  a  deep  red- 
ness, and  is  so  intensely  pained  as  hardly  to  bear 
the  gentlest  pressure. 

The  pains  are  almost  always  found  to  return 
within  a  few  years,  and,  after  a  few  visits,  to  make 
their  returns  oftener,  and  their  stay  longer,  ex- 
tending themselves  by  degrees  to  e\ery  part  of 
the  body,  which  they  enfeeble,  or  harass  with 
ehalky  sores,  or  make  useless  by  the  effects  of 
frequent  inflammations  in  destroying  the  motion 
of  the  joints. 

They  are  apt  to  desert  the  limbs,  and  fall  upon 
the  stomach,  lungs,  heart,  or  brain. 

They  seldom,  if  ever,  attack  any  who  are  not 
past  the  years  of  puberty. 

Lastly,  they  are  for  the  most  part  transmitted 
to  the  descendants  of  those  who  have  suffered  in 
any  considerable  degree. 

These  appear  to  me  to  be  the  marks  of  th^ 
genuine  gout,  in  almost  every  one  of  which  it  dif- 
fers from  what  I  would  call  the  rheumatism.  For 
this  does  not  begin  in  the  foot  preferably  to  any 
other  part ;  and  it  seldom  continues  long  in  the 
same  place,  but  will  be  perpetually  wandering 
over  the  whole  body,  even  during  the  first  fit, 
which  has  been  known  to  last  for  several  months. 


History  and  Cure  of  Diseases.         47 

Rheumatic  pains  will  come  on  suddenly,  and 
without  any  preparatory  symptoms. 

In  rheumatisms,  the  chief  pain  arises  from  mov- 
ing the  part  affected,  which  while  at  rest  gives 
for  the  most  part  rather  the  sensation  of  lassi- 
tude, than  of  anguish  and  torture. 

The  discolouring  of  the  skin,  if  there  be  any, 
is  not  a  deep  red,  but  rather  a  faint  blush. 

A  severe  fit  of  the  rheumatism  often  happens 
without  ever  returning  through  a  very  long  life, 
and  hardly  ever  makes  periodical  returns  like  the 
gout. 

Rheumatic  pains  very  rarely  desert  the  mus- 
cles and  joints,  to  seize  upon  the  vital  parts. 

Very  young  children  will  labour  under  violent 
rheumatisms ;  and  particularly  those  who  have  in 
them  by  inheritance  the  seeds  of  a  gout  with 
which  they  are  to  be  afflicted  when  they  arrive  at 
manhood. 

These  are,  according  to  my  judgment,  the  prin- 
cipal characters  of  the  two  distempers ;  but  it 
must  be  owned  that  there  are  cases,  in  which  the 
criteria  of  both  are  so  blended  together,  that  it  is 
not  easy  to  determine  whether  the  pains  be  gout 
or  rheumatism. 

The  difficulty  of  distinguishing  these  two  mala- 
dies will  be  of  the  greater  or  less  moment,  ac- 
cording to  the  result  of  a  very  important  inquiry; 


48  Commentaries  on  the 

namely,  how  far  these  two  distempers,  which, 
though  of  the  same  family,  are  marked  with  such 
different  features,  resemble  one  another  in  the 
treatment  and  cure  which  they  require.  Most 
practitioners  indeed  have  formerly  determined, 
that  the  remedies  against  the  gout  and  rheuma- 
tism are  of  a  directly  opposite  nature  ;  that  no 
cordials  are  too  strong  for  the  one,  and  no  eva- 
cuations too  plentiful  for  the  other.  Sydenham 
condemns  taking  away  blood  in  the  gout ;  but  in 
the  rheumatism  advises  not  less  than  four  copious 
bleedings  within  the  space  of  six  or  seven  days, 
and  sometimes  repeated  the  bleeding  oftener. 
However  in  his  later  writings*  he  is  manifestly 
disposed  to  abate  a  little  of  the  violence  of  this 
method,  which  he  owns  to  have  found  attended 
in  one  patient  with  great  inconveniences. 

Since  Sydenham's  time  the  antiphlogistic  treat- 
ment appears,  upon  further  trial,  to  have  lost  still 
more  ground.  The  time  may  come  when  the 
gout  will  be  treated  more  as  an  inflammatory  dis- 
temper, and  evacuations  less  plentifully  employed 
in  rheumatisms ;  so  that  the  cures  of  the  two  dis- 
eases may  at  last  approach  very  near  to  each  oth- 
er. The  Portland  powder  professes  itself  equal- 
ly adapted  to  both ;  and  some  medicines  of  this 
sort,  with  an  occasional  use  of  opium,  may  at 
length  be  found  the  most  efficaciuos  anti-arthritic 
and  anti-rheumatic  remedies. 

*  The  conclusioft  of  his  first  Epist.  Resp. 


ttistory  and  Dure  of  Diseases.         49 


CHAPTER  10. 

jiscarides. 

Some  symptoms  afford  very  probable  reasons 
to  conjecture  that  there  are  worms  in  the  sto- 
mach or  bowels;  but  no  certain  judgment  can  be 
formed  that  they  ever  have  been  there,  unless  the 
patient  has  actually  voided  them  :  and  great  care 
should  be  taken  not  to  be  imposed  upon  by  the 
appearance  of  a  ropy  slime,  which  is  often  mis- 
taken for  worms,  or  is  supposed  to  be  the  vagina 
of  worms ;  though  I  have  no  experience  to  satisfy 
me  that  real  worms  ever  have  such  a  sheath  or 
envelope.  It  has  been  known,  that  people  have 
voided  round  worms  without  being  sensible  of 
having  ever  felt  any  inconvenience  from  them ; 
and  others  have  all  the  supposed  effects  of  worms 
without  ever  voiding  a  worm  of  any  sort. 

The  ascarides  are  almost  always  attended  with 
an  itching  of  the  anus,  particular  in  the  evening; 
but,  this  symptom  excepted,  I  hardly  know  any 
which  peculiarly  belongs  to  them.  This  itching, 
and  the  consequent  rubbing  of  the  part,  occasion 
little  tumours  to  arise  about  the  anus,  which  are 
different  from  the  piles,  not  being  swelled  veins. 
Sickness,  gripings,  faintings,  tremblings,  indiges- 
tion, giddiness,  pains  of  the  head  and  stomach,  too 
much  or  too  little  appetite,  itching  of  the  nose, 
unquiet  sleep,  coughs,  offensive  breath,  have  all 
been  found  in  different  persons  together  with  as- 
carides ;   but  experience  teaches  us  that  none  of 

7 


50  Commentaries  on  the 

these  symptoms  are  necessarily  connected  with 
them  ;  and  therefore  it  is  doubtful,  whenever  they 
have  met,  whether  chance  or  the  nature  of  the 
distemper,  have  had  the  greatest  share  in  bring- 
ing them  together.  This  sort  of  worm  has  con- 
tinued for  twenty  or  thirty  years  without  doing 
any  considerable  injury  to  the  health.  They  not 
only  are  forced  out  with  the  excrement,  but  some- 
times, creep  out  of  the  body  of  their  own  accord, 
and  sometimes,  as  I  have  been  told,  even  through 
the  nostrils.  A  repetition  of  gentle  purges  alle- 
viates whatever  uneasiness  thej  may  occasion ; 
but  no  internal  medicines,  nor  clysters,  can  cer- 
tainly be  depended  upon  for  extirpating  them. 
Tobacco  clysters,  and  others  made  of  solutions  of 
sublimate  mercury,  have  had  little  or  no  eflfect. 


CHAPTER  11. 

jlsthma. 

The  first  fit  of  the  asthma  has  been  experienc- 
ed at  all  times,  from  the  earliest  infancy  to  ex- 
treme old  age,  and  in  every  intermediate  stage  of 
life.  Pleurisies,  peripneumonies,  and  frequent 
catarrhs,  often  end  in  this  distemper.  A  mal-con- 
formation  of  the  breast,  and  a  cough  returning 
every  winter,  and  becoming  worse  and  worse, 
bring  on  an  incurable  a&thma.  In  some  it  comes 
on  suddenly,  without  any  manifest  previous  ill- 
ness. Very  violent  fits  of  it  will  allow  long  inter- 
vals of  apparendy  perfect  freedom  from  anj  diffi- 
culty of  breathing.     There  have  been  instances 


History  and  Cure  of  Diseases.       51 

of  its  returning  every  other  day,  or  every  vt^eek, 
or  once  a  month,  or  three  or  four  times  in  a  year 
about  the  same  seasons,  or  every  spring  and  au- 
tumn, or  very  commonly  every  winter,  or  once  in 
two  years.  I  knew  one  who  was  visited  with  the 
asthma  once  in  seven  years,  six  or  seven  times ; 
but  it  more  frequently  returns  after  no  certain 
period.  I  have  met  with  those  who,  after  having 
struggled  with  this  distemper  for  several  years, 
have  had  an  entire  respite  for  near  thirty  years. 
Such  long  intervals  of  ease  are  indeed  very  rare  : 
it  more  usually  returns  every  year,  becoming  con- 
tinually worse  and  worse.  One  person  at  very 
distant  and  uncertain  periods  became  violently 
asthmatic  for  a  single  day ;  during  the  whole  of 
which  he  was  in  constant  danger  of  suffocation, 
but  afterwards,  for  a  considerable  time,  would  be 
entirely  free  from  it.  In  some  it  never  fails  to  be 
brought  on  in  certain  situations,  or  houses,  and  is 
not  felt  in  others ;  though  at  so  small  a  distance, 
that  it  is  difficult  to  satisfy  ourselves  in  fixing  upon 
the  circumstance  which  could  make  the  difference. 
There  have  been  those  who  have  lived  with  an 
asthma  for  fifty  years  ;  and  others  have  died  of  it 
in  a  few  months.  Some  few  constitutions  have 
of  themselves  either  outgrown,  or,  assisted  by 
some  judicious  methods  of  cure,  have  entirely 
conquered  the  asthma.  A  most  dangerous  asth- 
ma went  off  so  perfectly,  that  after  two  years  the 
patient  was  able  to  attend  to  business ;  and  in  an- 
other it  ceased  after  four  years.  In  one  it  came 
on  during  childhood,  and  often  returned  with 
such  vehemence,  that  it  was  expected  to  be  fatal; 
but  in  old  age  it  became  much  gentler,  and  for 
four  years  ceased  to  be  at  all  troublesome.     It  is 


52  Commentaries  on  the 

usually,  but  not  universally,  attended  with  a 
cou<rh,  which  makes  no  small  part  of  the  patient's 
sufferings.  After  being  troublesome,  together 
with  the  gout  once  every  year  for  fifteen  years, 
there  came  on  in  one  patient  all  the  signs  of  a 
broken  constitution,  and  for  five  years  neither 
gout  nor  asthma  appeared.  Wherever  there  is 
any  degree  of  asthma,  it  rarely  fails  of  showing 
itself  just  upon  waking  out  of  the  first  sleep. 
Though  it  be  right  to  keep  the  body  open  in  this 
distemper,  yet  a  spontaneous  diarrhoea  is  very 
undesirable ;  it  not  only  hinders  the  use  of  many 
anti-asthmatic  remedies,  which  are  most  of  them 
aperient,  but  it  shows  an  alarming  weakness,  and 
is  often  a  sign  of  the  last  stage  of  this  illness,  and 
a  forerunner  of  death,  especially  if  joined  with  a 
quick  pulse.  The  violent  fits  will  sometimes  last 
for  several  hours,  and  sometimes  only  a  very  few 
minutes.  A  vehement  asthma,  which  continued 
for  many  months,  became  of  itself  gentler,  and 
after  four  years  was  almost  gone.  Similar  in- 
stances will  sometimes  occur,  which  render  it  un- 
certain whether  relief  be  obtained  by  the  efforts 
of  nature,  or  by  the  effects  of  medicine. 

In  some  a  difficulty  of  breathing  has  returned 
periodically,  like  a  tertian  fever,  and  has  yielded 
to  the  Peruvian  bark. 

Motion  brings  it  on,  and  in  some  there  is  not 
the  least  sign  of  such  a  disorder,  but  when  they 
move,  except  just  at  waking  out  of  a  sound  sleep. 
The  lying  down  in  bed  is  particularly  apt  to 
make  the  breathing  very  laborious,  and  it  will  of- 
ten be  an  hour  or  more  before  the  lungs  can  tole- 


History  and  Cure  of  Diseases.         53 

uably  do  their  duty  in  this  posture ;  and  they  are 
relieved  by  sitting  up,  and  bending  the  body  for- 
ward. A  very  rare  case  has  happened,  where 
lying  down  has  proved  a  rehef. 

Several  asthmas  cannot  bear  the  country  air, 
and  are  much  mure  tolerable  in  great  towns ;  but 
the  far  greater  number  are  impatient  of  cities, 
and  are  always  easiest  in  the  country.  Cold  fresh 
air  is  a  general  relief;  but  I  have  known  more 
than  one  asthma,  the  lits  of  which  were  moderat- 
ed by  sitting  before  as  great  a  fire  as  could  be 
borne.  Sometimes  any  change  of  air  is  benefi- 
cial. More  than  once  an  asthma  has  been  more 
tolerable  in  England  than  in  warmer  countries ; 
but  the  contrary  to  this  is  most  generally  expe- 
rienced. So  summer  is  to  not  a  few  the  time  of 
their  breathing  with  most  difficulty;  though  win- 
ter be  most  generally  the  dangerous  season.  A 
long  voyage  between  the  East  Indies  and  En- 
gland has  not  relieved  an  asthma.  In  most  per- 
sons, the  breath  is  shorter  and  more  difficult  after 
a  meal ;  but  in  a  few  it  has  been  easier.  A  copi- 
ous spitting,  and  a  sudden  oedematous  swelling  of 
the  lower  parts  of  the  body,  have  apparently  sav- 
ed asthmatic  persons  from  impending  death.  A 
violent  catarrh,  as  from  a  cold,  and  in  old  persons 
a  spitting  of  blood,  an  inflammation  of  the  leg  and 
a  consequent  ulcer,  a  palsy,  a  pain  in  the  stomach 
and  limbs,  cutaneous  eruptions,  and  a  fit  of  the 
gout,  have  all  seemed  to  divert  the  mischief  from 
the  lungs ;  and,  though  themselves  diseases,  have 
yet  proved  remedies  to  the  asthma.  But  yet  a 
fit  of  the  gout  has  partaken  of  that  uncertainty 
so  remarkable  in  the  effects  of  many  circumstan- 


54  Conunentaries  on  the 

ces  upon  asthmatic  patients  ;  for  if  it  have  cured 
some,  it  has  brought  the  asthma  on  others,  or  at 
least  has  not  hindered  a  fit  of  it  from  succeeding 
immediately  to  a  fit  of  the  gout.  Issues  may 
sometimes  be  serviceable,  but  are  too  often  use- 
less. Emetics  not  unfrequently  procure  easy 
breathing ;  but  cathartics  are  so  very  seldom  use- 
ful, as  scarcely  to  deserve  being  ever  tried.  A 
large  spoonful  of  mustard-seed  taken  every  mor- 
ning has  been  successful  in  keeping  the  fits  off; 
and  so  crude  quicksilver,  and  cinnabar,  are  said 
to  have  been ;  and  yet  a  course  of  mercurial  oint- 
ment has  several  times  brought  on  a  difficulty  of 
breathing.  Spirituous  liquors,  strong  coffee,  the 
smoking  of  tobacco,  garlic,  squills,  and  solutions 
of  the  fetid  gums,  afford  some  present  ease  in  a 
fit ;  and  so  will  the  opening  of  a  vein,  and  the 
taking  away  a  little  blood  :  but  it  may  be  doubt- 
ed whether  bleeding  be  ever  useful  in  any  other 
states  of  an  asthma,  besides  that  of  the  patient's 
being  in  danger  of  instant  suffocation  :  it  is  un- 
doubtedly often  mischievous  by  unnecessarily  wast- 
ing the  strength,  and  hastening  the  dropsy,  in 
which  an  asthma  usually  ends.  Opium  is  a  pow- 
erful remedy  in  some  asthmas,  when  all  other 
means  have  failed  :  is  it  not  useful  in  all  ? 

It  is  observable  in  pulmonary  consumptions, 
•where  the  whole  lungs  are  diseased,  and  where  a 
great  part  of  them  has  been  destroyed,  that  pa- 
tients have  indeed  a  shortness  of  breath  upon  mo- 
tion, but  not  any  of  the  violent  fits  of  suffocation 
which  belong  to  asthmas ;  while  in  examining  the 
lungs  of  asthmatic  persons  after  death,  there  has 
sometimes  appeared  no  hurt  obvious  to  the  sen- 


History  and  Cure  of  Diseases.  55 

ses,  which  cauld  account  for  the  difficulty  with 
which  they  had  often  performed  their  office.  If 
we  further  consider  the  long  intervals  of  breath- 
ing with  perfect  freedom,  which  this  distemper 
frequently  allows,  and  likewise  the  nature  of 
many  of  its  remedies,  and  that  it  will  be  caused 
by  sleep,  grief,  anger,  terrour,  joy,  or  a  fit  of 
laughter,  it  must  seem  probable,  that,  besides  va- 
rious other  causes  of  an  asthma,  it  is  in  many  in- 
stances owing  to  some  disturbance  of  those  func- 
tions which  are  attributed  to  the  nerves. 

The  lungs  of  a  very  asthmatic  man  appeared 
perfectly  sound,  and  so  did  the  heart  and  dia- 
phragm :  there  was  neither  water  nor  pus  in  the 
thorax,  nor  was  any  thing  preeternatural  discover- 
ed, except  some  exostoses  of  the  vertebrae  of  the 
thorax. 

A  woman  had  laboured  with  an  asthma  gradu- 
ally increasing  for  eight  months.  She  used  to  sit 
with  her  body  bending  forwards,  or  a  little  in- 
clining to  the  left  side,  never  to  the  right.  The 
pulse  was  extremely  irregular.  Her  legs  swelled 
(the  left  more  than  the  right,)  and,  being  punc- 
tured, a  great  deal  of  water  had  flowed  from  them. 
A  little  before  her  death,  a  fetid  saliva  flowed 
plentifully  out  of  her  mouth.  She  was  opened, 
and  no  water  was  found  in  the  abdomen  or  tho- 
rax. The  lungs  were  sound,  and  free  from  adhe- 
sions. In  the  aorta,  auricles,  and  ventricles,  were 
found  rough  polypose  concretions,  and  the  valves 
between  the  left  auricle  and  left  ventricle  were 
contracted  into  irregular  hard  tuberosities. 


56  Commentaries  on  the 

Upon  opening  the  thorax  of  an  asthmatic  man, 
the  hmgs  continued  to  be  inflated  :  their  surface 
was  full  of  air  bubbles  inclosed  in  a  very  thin 
membrane  ;  when  one  of  these  was  opened,  none 
of  the  others  subsided.  There  was  no  other  ap- 
pearance of  distemper  about  the  thorax  or  lungs. 


CHAPTER  12. 

Aiirium  Morbi» 

In  children  particularly,  and  also  in  grown 
persons,  a  moisture  is  rpt  to  exclude  behind  the 
ears,  smelling  ofFensivelj,  and  occasioning  the 
ears  and  neighbouring  parts  to  swell,  and  mak- 
ing the  scarf  skin  come  off  in  a  branny  scurf,  or 
more  deeply  fretting  it,  so  as  to  make  the  parts 
sore  and  scabby.  The  inside  of  the  ear  is  liable 
to  be  affected  in  a  similar  manner,  and  with  a 
more  purulent  discharge,  not  without  some  de- 
gree of  deafness.  The  checking  of  this  dis- 
charge by  drying  applications  is  very  hurtful : 
nothing  more  needs  be  done,  than  to  keep  the 
parts  clean  by  washing  them  with  warm  water, 
and,  by  means  of  a  rag  smeared  with  any  mild 
ointment,  to  prevent  them  from  sticking  together, 
or  to  the  clothes. 

A  singing  of  the  ears  may  continue  for  several 
years,  considerable  enough  to  interrupt  the  at- 
tention by  day,  and  the  sleep  by  night,  without 
either  deafness  or  any  other  disorder  joined  with 
it ;  but  yet  in  several  cases  it  is  found  to  arise 


History  and  Cure  of  Mseases.       57 

from  such  causes  as  will  bring  on  confusion  in  the 
head,  disturbed  thoughts,  deafness,  blindnefis, 
fainting,  giddiness,  forgetfulness,  slight  delirious- 
ness,  epilepsies,  palsies,  and  apoplexies. 

Solutions  of  the  fetid  gums,  opium,  blisters  be- 
hind the  ears,  valerian  root,  sternutatory  powders, 
may  sometimes  relieve,  but  will  not  always  sub- 
due these  evils. 

In  consequence  of  a  violent  blow  upon  the  head 
or  ear,  1  have  two  or  three  times  been  witness 
to  a  copious  discharge  of  water  from  the  ear, 
either  clear  or  lightly  tinged  with  blood,  especial- 
ly on  holding  the  head  down,  by  the  account  of 
one  of  these  patients,  there  came  not  less  than  a 
pint  every  day  ;  but  this  must  have  been  said  by 
conjecture,  for  it  could  not  easily  have  been  mea- 
sured— Whence  did  this  come  r 

A  polypus  may  be  formed  in  the  ears  as  well 
as  in  the  nose. 

Deafness,  if  owing  to  hardened  wax,  will  be 
oured  by  injecting  an  infusion  of  camomile  flow-, 
ers  ;  if  the  deafness  be  of  a  paralytic  nature,  blis- 
ters may  be  applied  behind  the  ears,  or  four 
drops  of  camphor  julep  without  sugar  may  be 
dropped  into  each  ear,  to  too  ounces  of  which 
there  may  be  added  half  an  ounce  of  cathartic 
salt ;  or  a  snuff  of  asarabacca  leaves  may  be  taken 
every  night.  But  these,  and  all  other  means> 
which  I  have  ever  seen  used,  have  in  too  many 
cases  proved  of  little  or  no  avail.  If  the  gene- 
rality of  deafnesses  be  not  incurable,  a  discovery 


58  Commentaries  on  the 

of  the  proper  remedies  is  one  of  the  many  desi- 
derata in  the  art  of  healing. 


CHAPTER    13. 

Of  the  Bath  Waters. 

The  difficulty  of  ascertaining  the  powers  of 
medicines,  and  of  distinguishing  their  real  effects 
from  the  changes  wrought  in  the  body  by  other 
causes,  must  have  been  felt  by  every  physician  : 
and  no  aphorisai  of  Hippocrates  holds  truer  to 
this  day,  than  that  in  which  he  laments  the 
length  of  time  necessary  to  establish  medical 
truths,  and  the  danger,  unless  the  utmost  cau- 
tion be  used,  of  our  being  misled  even  by  expe- 
rience. This  observation  is  fully  verified  in  the 
uncertainty,  under  which  we  still  remain  in  re- 
gard to  the  virtues  of  the  waters  of  Bath.  Few 
medicines  have  been  more  repeatedly  tried  under 
the  inspection  of  such  numerous  and  able  judges  ; 
and  yet  we  have  had  in  the  present  age  a  dis- 
pute between  those  who  by  their  experience  and 
sagacity  were  best  qualified  to  decide  this  ques- 
tion, in  which  one  side  asserted  that  paralytic 
patients  were  cured,  and  the  other  that  they  were 
killed,  by  the  use  of  these  waters.  Such  con- 
trary decisions,  so  disreputable  to  physicians,  and 
so  perplexing  to  the  sick,  could  never  have  hap- 
pened after  so  long  a  trial,  if  a  very  small  part  of 
those,  whose  practice  had  afforded  them  frequent 
0{)portunities  of  observing  the  effects  of  Bath 
waters,  had  told  the  public  what  in  their  judg- 


History  ami  Chive  of  Diseases.        59 

ment  was  to  be  hoped  or  feared  from  them.  It 
is  probable  that  in  some  cases  it  would  have  been 
almost  unanimously  determined  they  do  good ; 
in  others,  that  they  do  no  harm,  though  it  might 
be  doubtful  whether  they  be  of  much  use  :  in  a 
third  sort  they  would  be  generally  condemned : 
and  in  a  fourth  class  of  diseases,  some  might 
judge  them  to  be  beneficial,  and  others  detrimen- 
tal. 

Wherever  the  generality  of  voices  passed  either 
of  the  two  first  sentences  upon  these  waters, 
there  the  use  of  them  might  be  advised,  or  per- 
mitted, without  any  hesitation  ;  and  all  should  be 
cautioned  against  them,  where  a  great  majority 
agreed  that  they. were  hurtful.  It  would  be  no 
great  loss  to  avoid  going  to  Bath,  in  cases  where 
the  weight  of  evidence  was  so  equally  divided, 
as  to  make  it  doubtful  whether  the  waters  were 
a  remedy,  or  a  poison  :  for  the  probability  is,  that 
in  all  such  disorders  they  are  in  reality  insignifi- 
cant, and  that  the  patients  who  use  them  either 
recover  by  other  medicines,  or  the  strength  of 
their  constitutions,  or  else  sink  under  the  natural 
progress  of  their  diseases.  It  is  here  taken  for 
granted,  that  no  chemical  analysis  can  do  much 
towards  ascertaining  the  virtues  of  these  mineral 
springs,  but  that  almost  all  our  useful  knowledge 
of  them,  as  medicines,  must  be  gained  from  ex- 
perience. Their  virtues  may  be  considered  either 
as  they  are  used  externally,  or  internally. 

Externally  used,  either  by  immersing  the  whole 
body,  or  by  deriving  a  stream  to  some  particular 
part,  they  appear  to  be  serviceable  against  con- 


"Mmi 


eo  Commmmms  on  the 

tractions  and  other  spasmodic  affections  of  the 
muscles.  In  slight  cutaneous  disorders,  warm 
bathing  will  sometimes  clear  the  skin  for  a  little 
while,  but  can  hardly  be  considered  as  a  cure. 
It  has  been  a  doubt  with  me,  whether  any  weak- 
nesses left  by  the  rheumatism,  gout,  or  palsy, 
have  been  sooner  removed  by  bathing  at  Bath, 
than  they  would  have  been  without  it.  In  some 
patients  these  weaknesses  have  been  manifestly 
increased  after  a  course  of  bathing  at  Bath  ;  and, 
according  to  my  experience,  cold  bathing  in  these 
cases  is  preferable.  It  is  by  no  means  clear  to 
me,  that  the  external  use  of  Bath  water  is  more 
beneficial  than  that  of  equally  warm  common  wa- 
ter, or  at  all  different  from   it. 

Internally,  these  springs  are  of  singular  use  in 

remedying  the  morning   sickness   and    vomiting, 

the  loss  of  appetite,  pains    of  the  stomach,  and 

other  ill  eflfects  of  hard  drinking,  where  it   has 

not  been  so  long  continued   as  to  make   the  liver 

schirrous,  or  to  bring  on  a  dropsy ;  for  in   both 

these  cases  they  are  so  far  from  relieving,  that 

they  aggravate  the  patient's  misery,  and  hasten 

his  death.     They  are  so  generally   beneficial  in 

other  disorders  of  the  stomach  and  bowels,  that 

the  probability  of  considerable  benefit  will  make 

them  very  well  worth  any  one's  trying,   who  is 

afflicted  with  indigestion,   a  chronical  diarrhoea, 

hiccup,   flatulency,   vomiting,  or   any   spasmodic 

affections,  and    weaknesses,   and   pains   of  these 

parts,  provided  the  pulse  be  in   a  natural   state. 

For  if  there  be  no  signs  of  hectical  feverishness, 

I  never  had  reason  to  suspect  that  Bath  was  pre-f 

judicial   in  any  of  these  complaints,    though  it 


History  and  Cure  of  Diseases.        61 

may  have  sometimes  failed  of  being  a  cure.  But 
1  have  never  yet  been  able  to  satisfy  myself, 
amidst  the  endless  variety  of  these  ails,  upon 
what  particular  circumstances  it  has  depended, 
that  in  some  it  has  not  been  attended  with  suc- 
cess. 

Many  judicious  and  experienced  physicians 
have  a  favourable  opinion  of  the  internal  use  of 
Bath  water  in  flying  pains  and  weaknesses  of  the 
limbs,  in  rheumatisms,  and  in  the  simple  jaundice, 
where  the  liver  is  not  diseased.  From  the  cases 
of  this  sort  which  have  fallen  under  my  observa- 
tion, I  should  rather  conclude  it  to  be  innocent  in 
them,  than  of  any  great  use.  More  perhaps 
ought  to  be  said  in  its  commendation  in  the  colic 
of  Poitou  ;  and  yet  it  appears  difficult  to  find  a 
time  in  this  cruel  disorder  when  we  would  wish 
to  apply  to  Bath.  During  the  paroxysm,  while 
the  bowels  are  in  torture,  much  stronger  medi- 
cines are  indispensably  necessary  to  the  ease  and 
safety  of  the  patient :  after  the  fit  is  ended,  if  the 
limbs  do  not  become  paralytic,  I  suppose  the  pa- 
tient would  remain  well  without  any  relapse,  if 
the  manner  in  which  lead  had  been  introduced 
into  the  body  could  be  found  out,  and  a  stop  be 
put  to  its  ever  being  introduced  again.  For  all 
my  experience  tends  to  make  me  believe  with  the 
learned  and  judicious  Sir  George  Baker,  that  lead 
is  the  sole  cause  of  this  distemper,  though  it  be 
difficult  in  many  cases  to  trace  its  admission  into 
the  stomach.  Some  of  the  worst  fits  of  this  colic, 
from  which  I  ever  saw  the  patient  recover,  when 
the  cause  was  known,  and  could  be  avoided,  have, 
by  keeping  out  of  its  ree^ch,  never  returned  in 


6S  Commentaries 'on  the 

many  years  ;  from  which  it  is  probable  there  was 
no  fomes  rnorbi  left.  I  have  hkewise  observed 
this  happen  in  a  more  chronical  kind  of  this  colic, 
where  the  Hmbs  were  become  semi-paralytic;  the 
weakness  of  which  gradually  abated,  and  the 
pains  never  returned,  after  leaving  off  the  use  of 
white  Lisbon  wine,  the  drinking  of  a  pint  of  which 
every  day  was  conjectured  to  have  brought  on 
this  malady.  Now,  if  the  manner  in  which  this 
poison  insinuates  itself  be  undiscoverable,  and  so 
cannot  be  guarded  against,  there  neither  Bath 
nor  any  other  known  means  would,  in  my  opinion, 
prevent  the  return  of  these  torments,  nor  hinder 
them  from  ending  in  a  lingering  death.  But  it 
may  be  supposed  that  a  person  has  taken  so  much 
of  this  poisonous  metal,  as  may  be  sufficient,  with- 
out any  repetition,  to  occasion  frequent  fits  of  the 
colic,  and  to  bring  on  at  last  the  paralytic  weak- 
ness peculiar  to  it ;  and  tliat  these  bad  effects 
may  possibly  be  obviated  by  drinking  the  Bath 
waters,  or  that  the  weakness  may  be  cured  by 
them  after  it  has  been  brought  on.  How  much 
truth  there  is  in  these  suppositions  I  know  not, 
but  I  can  easily  allow  them  so  much  weight,  as  to 
be  sufficient  reasons  for  the  use  of  the  Bath  wa- 
ters in  these  circumstances,  as  they  are  unques- 
tionably safe,  and  as  I  fear  we  are  in  want  of  oth- 
er remedies  upon  which  we  might  with  more  cer- 
tainty depend.  Besides,  in  all  chronical  illnesses, 
where  these  waters  are  innocent^  there  will  be  a 
good  reason  for  any  one's  taking  a  Bath  journey, 
who  can  afford  it,  in  the  benefit  which  he  may 
hope  to  receive  from  the  change  of  water,  and 
air,  from  the  breaking  of  some  unhealthful  habits, 
and  from  that  suspension  of  business  and  cares, 


History  and  Cure  of  Diseases.         63 

in  which  the  visiters  of  Bath  indulge  themselves ; 
all  which  circumstances  make  a  place  of  this  sort 
highly  useful  in  establishing  the  general  health. 

The  Bath  waters  have  always  appeared  to  me 
unquestionably  prejudicial  in  all  schirrous  and  ul- 
cerous affections  of  the  lungs,  or  of  the  abdominal 
viscera.  They  increase  the  hectical  heat  which 
usually  attends  such  maladies,  and  speedily  put 
an  end  to  what  little  hopes  might  have  been  en- 
tertained of  their  cure.  All  patients  therefore  of 
this  sort  cannot  be  too  earnestly  warned  against 
meddling  with  the  Bath  waters,  if  they  would 
avoid  making  their  condition  utterly  desperate ; 
which  with  the  greatest  care,  and  under  the  best 
management,  is  always  dangerous. 

In  extreme  dejection  of  spirits,  languor,  lassi- 
tude, inattention,  trembhngs,  catchings,  faintings, 
giddiness,  confusion  of  the  head,  and  palpitations 
without  any  other  apparent  distemper,  which  are 
usually  called  hypochondriac,  hysteric,  or  ner- 
vous ;  in  all  these  whether  the  patients  had  used 
the  water  externally,  or  internally,  I  have  observ- 
ed them  return  worse  from  Bath ;  but  I  hardly 
ever  knew  them  better,  if  we  except  only  some  lit- 
tle relief  of  the  pains,  and  flatulence,  and  acidi- 
ties, which  often  accompany  the  before-mentioned 
symptoms.  Nor  does  the  vacancy  of  a  Bath  life 
suit  complaints,  which  are  more  frequently  caus- 
ed by  too  little,  than  too  much  application  and 
employment.  It  will  indeed  sometimes  happen, 
that  some  degree  of  these  miserable  sensations 
will  be  produced  by  a  too  great  weight  of  busi- 
ness ;  the  vexations  of  which  in  some  evil  hour 


64  Commentaries  on  the 

may  entangle  a  man  so  much,  as  to  disable  him 
from  extricating  himself  by  his  own  struggles,  un- 
less for  a  while  he  eases  himself  of  the  load  by 
retiring  to  some  such  place  as  Bath,  where  the 
manner  of  living  will  effect  the  cure,  though  the 
reputation  of  it  may  be  put  to  the  account  of  the 
waters.  The  same  often  happens  in  that  languor 
and  weakness,  which  aie  left  by  a  long  illness, 
and  require  only  time  and  quiet  for  their  remo- 
vaL 


CHAPTER  14. 

Of  the  Bristol  Water. 

The  water  of  Bristol  is  celebrated  for  its  purir 
iy^  and  for  its  virtues  in  consumptions,  and  seve- 
ral weaknesses.  It  has  certainly  no  claim  to  be 
thought  a  pure  water ;  and  as  far  as  my  expe- 
rience goes,  it  has  as  little  just  pretence  to  any  of 
the  medicinal  virtues  which  it  has  been  thought 
to  possess. 


CHAPTER  15. 

Bronchocele, 

A  SWELLING  of  the  thyroidal  gland  is  endemial 
in  some  parts  of  Derbyshire,  Buckinghamshire, 
and  Surry,  and  is  sometimes  seen  in  persons  who 
live  in  other  parts  of  England,  where  this  disor- 
der is  not  commonly  known.     It  chiefly  affectis 


History  and  Cure  of  Diseases,       65 

women,  and  the  younger  part  of  them  ;  and  is 
probably  the  same  with  the  Alpine  swelled  throat, 
which,  though  so  old  a  distemper,  has  not  yet 
been  found  to  endanger  the  hfe,  or  disorder  the 
health,  or  to  be  worth  regarding  on  any  other  ac- 
count than  that  of  its  deformity:  though  I  have 
seen  some,  who  have  complained  of  its  giving 
them,  in  certain  situations,  a  difficulty  of  fetching 
their  breath.  The  cause  of  this  malady  is  most 
probably  to  be  found  in  the  peculiar  nature  of  the 
water  in  those  places  where  it  is  common  ;  a  judi- 
cious examination  of  which  is  greatly  wanted.  I 
never  saw  this  swelling  come  to  suppuration.  A 
course  of  sea  water,  or  of  solutions  of  any  of  the 
neutral  salts,  a  removal  from  the  place,  or  the 
drinking  only  of  the  Malvern,  or  distilled  water, 
appear  to  be  the  most  useful  means  of  reducing 
the  swelling,  or  of  preventing  its  return. 


CHAPTER    16. 

Calculus  Urince,^ 

Women  are  much  less  subject  to  calculous  con- 
cretions than  men ;  they  do  not  so  readily  form 
them,  and  more  easily  get  rid  of  them. 

There  is  some  difficulty  in  ascertaining  both 
the  presence  of  a  stone,  and  its  place.     A  scir- 

*  Calculi  are  formed  in  many  other  parts  of  the  body.  In  a 
woman,  after  great  pain  which  lasted  ten  days,  a  tumour  between 
the  mulares  and  tongue  broke,  and  there  came  out  a  calculus  as 
big  as  two  peas.  ^ 

9 


66  Commentaries  on  the 

rhoiis  swelling  of  the  prostrate  gland  may  be  so 
easily  mistaken  for  it,  that  I  have  known  a  consul- 
tation of  very  able  and  experienced  practitioners, 
where  they  were  divided  in  their  opinions  between 
these  two  causes  of  the  symptoms,  after  every 
kind  of  examination.  For  a  stone  may  be  in  the 
bladder  without  being  felt  by  the  catheter ;  of 
which  I  have  seen  some  very  remarkable  instan- 
ces, and  particularly  in  one  who  had  repeatedly 
been  examined  by  three  or  four  of  the  most  dex- 
trous and  experienced  surgeons  without  its  ever 
being  touched,  in  whose  bladder,  after  death,  a 
stone  was  found  weighing  5ij  3iij  ;  and  the  swel- 
ling of  the  prostate  may  not  be  large  enough  to 
put  its  diseased  state  out  of  all  doubt;  especially 
as  it  is  said  to  be  always  a  little  fuller  where  the 
neck  of  the  bladder  has  been  long  and  frequently 
molested  with  a  stone.  The  scirrhus  of  this  gland 
is  attended  with  an  irritation  to  make  water,  and 
consequently  with  a  prseternatural  quantity  of  mu- 
cus, for  it  always  is  in  proportion  to  the  degree 
of  irritation  :  there  are  besides  strangury  and  te- 
nesmus ;  which  symptoms  it  has  in  common  with 
the  stone.  Bloody  urine  in  a  scirrhus  of  the 
prostate  is  but  rarely  seen ;  the  quantity  is  small, 
and  is  not  increased  by  riding  as  in  calculous 
complaints.  Hard  faeces  give  pain  as  they  pass, 
and  the  testicles  are  apt  to  swell ;  which  symp- 
toms are  also  peculiar  to  the  diseases  of  the  pros- 
tale.  But  perhaps  the  best  criterion  for  distin- 
guishing these  two  maladies  is  the  effect  which  a 
scirrhus  has  upon  the  g-eneral  health  :  those  af- 
flicted with  it  lose  their  appetite,  their  flesh,  and 
their  strength,  and  have  irregular  shiverings,  with 
a  pulse  quicker  than  natural,  and  keep  constantly 


History  and  Cure  of  Biseases,  67 

growing  worse,  without  any  considerable  appear- 
ances of  amendment,  or  intervals  of  ease  :  where- 
as the  calculous  patient  has  long  respites  from  his 
pains,  and  shews  no  sign  of  his  general  health  be- 
ing at  all  affected  when  the  fit  is  off:  and  these 
are  also  the  best  marks  which  distinguish  ulcers 
of  the  kidney,  or  bladder,  from  stones.  Bloody 
urine,  without  any  signs  of  internal  ulcers,  espe- 
cially if  brought  on  or  increased  by  motion,  al- 
most always  denotes  a  stone  somewhere  in  the 
urinary  passages.  I  remember  to  have  read  in 
books  of  other  causes  of  this  appearance,  which  I 
imagine  occur  but  seldom,  because  I  do  not  re- 
collect that  I  ever  yet  met  with  them. 

After  it  is  determined  that  there  is  a  stone,  a 
difficulty  often  remains  of  finding  the  part  in 
which  it  is  lodged :  but  this  is  a  matter  of  not 
much  importance  in  practice ;  for,  except  what 
ease  may  possibly  be  sometimes  given  by  the 
catheter  in  pushing  the  stone  from  the  neck  of 
the  bladder,  there  is  no  peculiar  solvent  of  the 
stone  in  the  bladder  different  from  that  of  the 
kidneys  ;  and  as  to  present  ease,  nothing  will  pro- 
cure it  in  either  case  so  well  as  opium. 

It  very  frequently  happens  that  there  is  a  stone 
both  in  the  kidney  and  bladder  at  the  same  time; 
and  in  such  cases  there  is  no  knowing  to  which 
of  the  causes  the  symptoms  are  to  be  referred. 
Coffee-coloured,  or  bloody  water,  without  any 
pain,  or  with  a  dull  pain,  or  a  sharp  pain,  a  little 
above  either  hip,  most  probably  proceeds  wholly 
from  a  stone  wounding  the  kidnejs:  vomiting 
sometimes  accompanies  a  nephritic  pain,  but  is 


68  Commentaries  on  tli£ 

far  from  being  constantly  joined  with  it:  a  numb- 
ness in  the  thigh  or  leg,  a  difficulty  of  bending 
the  body,  a  drawing  up  of  the  testicle  of  the  af- 
fected side,  and  a  pain  at  the  extremity  of  the 
urethra,  are  still  less  constant  symptoms. 

As  far  as  I  know,  we  are  wholly  in  the  dark 
about  the  particular  circumstances  which  make 
the  stone  of  the  kidneys  capable  of  exciting  such 
torments  in  some,  while  others  with  kidneys  to- 
tally plugged  up  with  calculous  matter  are  un- 
conscious of  any  thing  being  amiss.  Possibly 
the  different  sensations  of  people,  as  well  as  the 
surface  and  position  of  the  stone,  must  be  taken 
into  the  account ;  for  some  by  their  feeling  can 
trace  the  passage  of  a  stone  from  the  kidney  to 
the  bladder  through  the  whole  length  of  the  ure- 
ter, of  which  others  know  nothing.  Stones  are 
very  apt  to  make  some  stops  in  passing  the  ure- 
ter; and  wherever  they  do,  there  are  made  dila- 
tations in  it,  several  of  which  are  commonly  seen 
in  opening  the  bodies  of  calculous  persons. 

When  the  kidney  is  in  pain,  or  any  of  the 
neighbouring  parts,  there  will  necessarily  be 
formed  abundance  of  thick  mucus,  which  is  voided 
with  the  urine,  and  alarms  some  patients  with 
vain  apprehensions  of  an  ulcer.  A  violent  fit  of 
the  stone  will  occasion,  as  I  have  observed  in 
dissections,  a  slight  inflammation  of  the  kidneys, 
which  without  any  ulcer  causes  a  purulent  liquor 
to  exude  tVom  its  cavity;  and  this,  by  its  cream- 
like appearance  at  the  bottom  of  the  urine,  may 
give  juster  suspicions  of  an  ulceration.  The  reali- 
ty of  an  ulcer  may  be  principally  concluded  from 


History  and  Cure  of  Diseases,         69 

the  ^reat  quantity,  from  the  constant  flow,  and 
particularly  from  the  fetidness  of  this  hquor. 
Ulcers  of  this  part,  as  there  was  reason  to  judge, 
have  continued  for  several  years,  and  the  whole 
kidney  has  been  at  last  wasted,  just  as  it  happens 
with  the  lungs.  But  an  ulcer  only  in  one  of 
the  kidneys,  while  there  is  no  tendency  to  gan- 
grene or  cancer,  is  far  less  dangerous  to  life 
than  one  in  the  lungs,  and  the  recovery  from  it 
to  tolerable  health  may  more  reasonably  be  hoped. 

The  urine  of  a  w^oman  deposited  a  great  quan- 
tity of  fetid  mucus,  which  stuck  to  the  bottom  of 
the  vessel,  for  ten  months.  After  that  time 
streaks  of  blood  were  perceived  in  it,  without 
any  pain,  or  strangury,  not  even  from  riding  in  a 
carriage.  In  the  mean  time  her  general  health 
was  unimpaired.  Two  years  after,  when  she 
was  with  child,  there  came  with  the  urine  black 
fetid  lumps,  and  soon  after  the  urine  appeared 
wholly  bloody;  a  hiccup  came  on,  the  woman 
miscarried,  and  died.  The  right  kidney  was  filled 
with  calculous  matter,  the  pelvis  was  sphacelated 
and  full  of  fetid  pus ;  the  ureter  was  greatly  en- 
larged through  its  whole  length,  and  was  thick- 
ened and  hardened  almost  into  a  cartilage.  The 
left  kidney  also  contained  a  stone.  There  was 
no  stone  found  in  the  bladder.  Hence  we  may 
collect,  1st,  that  such  tenacious  mucus,  even 
though  fetid,  may  be  found  without  an  ulcer;  for 
it  probably  appeared  in  this  case  before  the  kid- 
ney had  suffered  any  other  injury  than  must  ne- 
cessarily attend  its  being  filled  with  stony  matter. 
2dly,  that  a  stone  in  the  kidneys  will  sometimes 
occasion  neither  pain  nor  strangury. 


70  Commentaries  on  the 

The  signs  of  a  stone  in  the  bladder  are,  great 
and  frequent  irritations  to  make  water,  a  stoppage 
in  the  middle  of  making  it,  and  a  pain  with  heat 
just  after  it  is  made ;  a  tenesmus,  pain  in  the  ex- 
tremity of  the  urethra,  incontinence  or  suppres- 
sion of  urine,  together  with  a  quiet  pulse,  and  the 
health  in  no  bad  state  :  all  which  symptoms  are 
most  commonly  aggravated  chiefly  by  riding,  but 
sometimes,  though  much  more  rarely,  by  walking, 
and  bloody  water  will  now  and  then  be  brought 
on  by  motion  ;  yet  in  some  few  persons  it  happens 
that  their  sufferings  from  stones  in  the  bladder, 
though  very  great,  have  not  been  perceivably  in- 
creased either  by  walking  or  riding.  This  I 
have  observed  in  cases  where  the  patients  were 
afterwards  cut,  or  opened  after  death,  and  the 
stones  in  the  bladder  were  found  to  be  the  sole 
cause  of  their  pains.  The  very  same  person  will 
at  different  times  be  perfectly  at  ease  in  a  coach, 
or  find  that  the  motion  is  intolerable.  The  tor- 
ment arising  from  the  stone  depends  more  upon 
its  figure  and  position,  than  its  size ;  but  there 
must  be  some  certain  situations  of  the  largest  and 
roughest  stone,  both  in  the  kidneys  and  bladder, 
in  which  little  or  no  inconvenience  is  felt  from  it. 
Were  it  otherwise,  the  life  of  a  calculous  patient 
must  be  one  continued  fit,  without  any  intervals 
of  ease ;  which  is  never  known  to  happen. 

It  is  too  often  seen  that  those,  who  have  once 
shown  a  disposition  to  have  the  calculous  matter 
formed  in  the  urinary  passages,  continue  subject 
to  it  during  their  whole  lives ;  and  this  disposition 
seems  also  to  be  hereditary.  But  still  examples 
occur  of  those  who  have  been  cut  for  the  stone  in 


History  and  Cure  of  Diseases.         71 

their  childhood,  and  afterwards  have  shown  no 
signs  of  forming  any  new  concretions  for  above 
fifty  years ;  and  1  have  known  others  who  had  felt 
several  fits,  and  voided  many  small  stones,  yet, 
when  they  were  opened  after  death,  showed  not 
the  least  appearance  of  any  stony  matter,  or  any 
other  disorder  in  their  kidneys  or  bladder.  But 
it  is  suspicious,  when  any  one  has  long  voided 
small  stones  or  sand  with  his  urine,  to  have  this 
appearance  suddenly  stopt  for  a  year  or  two  ;  for 
in  this  time  most  usually  a  stone  will  be  forming, 
and  shew  itself  at  last  by  its  proper  symptoms: 
in  this  state,  it  will  be  no  superabundant  caution 
to  enter  upon  a  course  of  such  remedies  as  will  be 
most  effectual  in  hindering  the  urine  from  deposit- 
ing any  fresh  calculous  matter. 

The  largest  stone  that  I  remember  having  ever 
seen  voided  by  a  man  with  his  urine,  weighed 
eight-and-twenty  grains ;  but  far  larger  have  come 
from  women.  All  motion  should  carefully  be 
avoided  when  it  brings  on  bloody  water;  for  a 
little  grume  of  blood  often  forms  the  nucleus  of  a 
stone. 

1  saw  a  stone  voided  by  a  woman,  of  an  oval 
form,  whose  larger  circumference  was  six  inches, 
and  the  less  four  inches.  She  was  delivered  of  a 
child  the  next  day  with  less  pain  than  she  had  felt 
in  parting  with  the  stone. 

The  remedies  against  calculous  complaints  are 
cither  such  as  relieve  the  pain  during  what  is 
called  a  fit  of  the  stone,  or  those  which  dispose 
the  urine  to  dissolve  the  stones,  and  so  make  a 


7S  Commentaries  on  the 

perfect  cure.  For  the  former  purpose  twenty 
drops  of  tlnctura  ppii,  or  as  much  more  as  may  be 
found  necessary,  mixed  with  four  or  hve  ounces 
of  warm  water,  or  oil,  and  given  in  a  clyster,  are 
the  most  effectual  means  which  I  have  ever  used ; 
and  much  more  to  be  depended  upon  than  any 
oily  draughts  or  emulsions  with  gum  dissolved  in 
them,  which  however  may  have  their  use.  The 
uva  ursi  has  lately  been  recommended  for  reliev- 
ing dysury  of  all  kinds  ;  in  my  hands  it  has  not 
very  well  answered  its  character ;  the  most  re- 
markable effect  which  I  ever  observed  from  it 
was,  that  upon  many  repeated  trials  it  constantly 
tinged  one  person's  urine  with  a  deep  green  colour  ; 
I  never  could  hear  of  its  doing  the  same  to  any  one 
else.  Lime  water  has  in  many  cases  appeared  to 
communicate  a  solvent  power  to  the  urine.  I 
have  known  it  used  for  several  years  as  the  only 
liquor,  and  by  custom  it  became  not  an  unplea- 
sant one.  The  person  who  took  it,  from  not 
being  able  to  walk  across  his  room,  could  bear  to 
be  carried  in  a  coach  without  springs  for  several 
miles  over  the  old  rough  pavement  of  London 
without  making  any  complaints ;  his  urine  in  a 
few  days  dissolved  a  fragment  of  a  calculus  im- 
mersed in  it,  which  had  before  been  steeped  in 
the  urine  of  two  other  persons  for  some  months 
without  losing  any  part  of  its  weight.  Soap  leys 
perhaps  communicate  a  stronger  solvent  power  to 
the  urine;  but  it  must  be  owned,  that  neither  of 
them  do  so  much  as  is  wanted  ;  their  effect  at  best 
is  very  slow,  and  upon  some  stones  they  seem  to 
have  none  at  all ;  lor  immersed  in  the  strongest 
undiluted  soap  leys  they  hardly  seem  to  waste. 
But  still  if  they  hinder  the  growth  of  many  stones, 


m 


History  and  Cure  of  Diseases.        73 

and  loosen  the  texture  of  those  already  formed, 
and  dissolve,  as   is  probable,   their  sharp  points, 
which  are  the  chief  causes  of  pain,  they  must  be 
considered  as  vahiable  medicines.     1  knew  a  per- 
son  who   took  half  an  ounce  of  soap  leys  almost 
daily  for  ten  years,  without  the  least  groimd  to 
surmise  that  it  had  any  ill  effect  upon  his  general 
health.     There  was  reason  to  believe  that  they 
had  helped  to  break  in  pieces  some  of  the  stones 
in  his  bladder ;  for  he  had  voided  some  ounces  of 
very  large  fragments  convex  on  one  side  and  con- 
cave on  the  other ;  and,  from  being  quite  confined 
to  his  house,  became  able  to  bear  a  coach,  and 
for  the  last  years  of  his  life  had  suffered  very  lit- 
tle pain,  of  which  he  used  to  have  frequent  and 
very  tormenting  fits.     But  yet  this  long  course 
persevered  in  so  steadily,  did  not  crumble  them 
all ;  for  after  his  death  one  kidney  was  found  full 
of  stone,  and  there  were  two  stones  in  the  blad- 
der, one  of  which  weighed  3vi.  Bii.  gr.  iv ;   the 
smaller  ^ij  gr.  xii.     It  appears  doubtful  whether 
either  lime  water  or  soap  leys  have  any  power 
over  the  stone  in  the  kidneys.     It  may  be  ques- 
tioned   whether  it   be   necessary  to  suspend  the 
use  of  these  lithontriptics  upon  account  of  bloody^ 
urine  or  a  fit  of  the  stone  ;  for  it  is  far  from  cer- 
tain that  they  can  increase  the  irritation  by  any 
acrimony  which  they  communicate  to  the  urine. 
However,  as  the  fits  usually  last  but  a  \ery  few 
days,  and  time  must  then  be  found  for  the  taking 
other  medicines,  there  can  be  no  great  loss,  and 
may   be   some   convenience,    in   interrupting   the 
course  of  these   remedies  until    the  fit  be  over. 
Have  not  too  strict  rules  been  laid  down  about 
the  wholly  avoiding  of  acids  in  the  diet  of  those 

10 


74  Commentaries  on  the 

who  take  lime  water  or  soap  leys  ?  The  power 
of  digestion  is  not  so  well  understood  as  to  ena- 
ble us  to  determine  how  long  it  will  be  before 
acids  are  changed  by  it  so  as  to  cease  from  hav- 
ing the  eifect  of  neutralizing  alkaline  substances. 
It  is  not  improbable  that  at  the  distance  of  a  very 
few  hours  they  may  have  wholly  lost  their  former 
nature.  The  fixed  air,  of  which  there  is  so  much 
not  only  in  the  primae  viae,  but  in  all  the  liquors 
of  the  body,  seems  at  least  as  likely  to  defeat  the 
efficacy  of  these  solvents,  by  saturating  them  with 
air,  and  destroying  their  power  of  extricating  the 
fixed  air  from  the  urinary  calculi :  and  it  is  in- 
deed very  mysterious  how  this  can  be  prevented. 


CHAPTER  17. 

Capitis  Dolor, 

The  nature  of  head-achs  is  extremely  obscure. 
Their  manifest  causes  are  very  various,  and  often 
contrary  to  one  another.  They  probably  there- 
fore arise  from  different  disorders,  and  some  of 
their  obscurity  may  be  owing  to  their  being  affec- 
tions of  a  part,  the  functions  of  which  are  but  lit- 
tle understood.  For  they  appear  to  be  seated  in 
the  brain  itself:  since  this  pain  is  peculiar  to  the 
head,  and  there  is  no  sensation  like  it  in  any  oth- 
er part  of  the  body,  but  all  the  parts  of  the  head 
except  the  brain  are  just  the  same  with  what  the 
rest  of  the  body  consists  of;  dissections  likewise 
have  shown  it  to  have  arisen  in  some  instances 
from  diseases  of  the  brain.     The  seat  then  of  this 


History  and  Cure  of  JDiseases,        75 

malady,  together  with  its  long  continuance  and 
frequency  of  return,  might  make  us  expect  that 
the  mischief  done  to  the  general  health  would  be 
great  and  lasting.  But  the  contrary  to  this  hap- 
pens. The  most  violent  head-achs  will  frequent- 
ly harass  a  person  for  the  greatest  part  of  his  life, 
without  shortening  his  days,  or  impairing  his  fa- 
culties, or  unfitting  him,  when  his  pains  are  over, 
for  any  of  the  employments  of  active  or  contem- 
plative life.  The  slightest  stroke  of  a  palsy  will 
often  be  more  detrimental  in  these  respects,  than 
head-achs  returning  often  and  with  great  violence 
from  childhood  to  the  beginning  of  old  age.  In- 
stead of  their  ruining  the  constitution,  nature 
seems  in  the  contest  to  get  the  better  of  them.  I 
have  observed  in  numberless  instances  that  th^y 
almost  always  become  milder,  and  generally  va- 
nish towards  the  decline  of  life.  This  considera- 
tion must  supply  the  place  of  a  remedy  where 
every  other  fails  ;  for  it  is  some  consolation  for  a 
man  to  know,  that  if  he  cannot  cure  his  distem- 
per, he  will  however  have  a  good  chance  to  out- 
live it.  This  is  true  likewise  of  tlfat  head-ach 
mentioned  among  the  diseases  of  the  eyes,  which 
begins  with  a  mist  before  the  sight. 

The  hemicrania,  or  pain  of  one  half  of  the 
head,  was  very  early  distinguished  by  medical 
writers  from  the  other  species  of  head-achs  :  but 
we  have  not  yet  advanced  much  in  knowing  how 
this  differs  from  other  pains  of  the  head,  except 
in  the  circumstance  which  the  name  denotes.  It 
has  happened  that  I  have  oftener  heard  of  this  oh 
the  left  side  than  on  the  right ;  but  I  believe  this 
to   have    been   merely   accidental.      Like   other 


76  Commentaries  on  the 

head-achs,  it  will  continue  to  return  through  a 
person's  whole  life  :  it  will  attend  the  gout,  and 
not  be  relieved  by  it ;  and  it  is  what  follows  that 
mist  before  the  eyes  which  makes  a  part  of  every 
object  invisible.  A  still  more  narrowly  limited 
pain  than  this  is  often  complained  of  over  the  left 
eye,  scarcely  extended  beyond  a  space  which 
might  be  covered  with  the  top  of  a  finger.  This 
will  last  a  day  or  two,  and  return  two  or  three 
times  in  a  month.  Is  it  not  most  common  in  wo- 
men, and  often  joined  with  hysteric  symptoms  ? 
Some  pains  seize  upon  the  back,  others  upon  the 
fore  part  only  of  the  head.  There  may  be  other 
varieties  of  the  place  affected,  which  it  is  hardly 
worth  while  to  remark,  unless  more  use,  than  I 
know,  could  be  made  of  them  in  discovering  their 
nature,  and  directing  us  to  the  cure.  1  say  no- 
thing of  Venereal  head-achs,  which  are  distin- 
guishable by  their  being  chiefly  troublesome  at 
night,  and  by  being  joined  with  other  symptoms 
of  this  distemper,  and  by  yielding  to  its  proper  re- 
medies. 

Spring  or  autumn,  or  both,  are  the  times  when 
some  head-achs  constantly  return  ;  others  are  sure 
to  be  felt  just  after  sleeping.  A  few  are  most 
troublesome  in  summer,  but  more  in  winter.  Of 
far  the  greatest  number  of  head-achs  it  is  true 
that  they  are  indifferent  to  all  seasons ;  and  their 
returns  are  totally  irregular,  and  not  to  be  reduc- 
ed to  any  rule  :  and  so  is  the  duration  of  the  pain, 
which  may  last  a  few  hours,  or  a  day,  or  a  week, 
or  not  cease  entirely  for  many  years.  Some 
great  change  in  the  constitution  has  removed  a 
nead»ach  which  had  continued  frotp  infancy.     It 


History  and  Cure  of  Diseases.        77 

has  ceased  upon  the  coming  on  of  an  asthma ; 
and  there  have  been  many  instances  of  its  leaving 
women  during  every  pregnancy,  who  were  hard- 
ly ever  free  from  it  at  any  other  time. 

Disagreeable  as  this  pain  is,  it  is  not  the  whole 
which  is  felt  by  all  those  who  suffer  it.  Giddiness 
will  in  some  precede  a  fit,  but  this  has  more  fre- 
quently joined  itself  to  an  old  head-ach.  Confu- 
sion of  vision,  flashes  of  light,  the  darkening  or 
colouring  of  objects,  stupor,  and  tightness  of  the 
head,  are  the  certain  companions  of  many  head- 
achs ;  and  so  are  all  sorts  of  hysteric  symptoms, 
such  as  shiverings,  cold  sweats,  fainting,  coldness 
of  the  feet,  numbnesses,  lethargic  heaviness,  noises 
in  the  head,  loss  of  voice  and  sight  for  a  short 
time,  catchings,  convulsions,  light-headedness.  The 
intenseness  of  the  pain  will  sometimes  leave  a 
soreness  of  the  head  for  a  day.  Great  disorders 
also  of  the  stomach  are  sometimes  united  with 
head-achs,  such  as  flatulence,  a  sense  of  fulness, 
uneasiness,  pain,  heartburn,  sickness,  vomiting, 
diarrhoea,  and  worms :  in  very  many  patients 
these  two  parts  suffer  alternately  ;  whenever  the 
head  is  well,  the  stomach  is  uneasy,  and  vice  ver- 
sa. This  view  of  the  complaints  which  are  often 
connected  with  head-achs,  makes  it  probable  that 
the  head  is  not  always  primarily  affected,  but 
sometimes  suffers  by  sympathy  with  the  stomach, 
which  is  the  original  seat  of  the  malady.  The 
healing  of  old  sores,  and  of  other  cutaneous  dis- 
tempers, and  the  menstrual  irregularity  of  wo- 
men, more  frequently  affect  the  stomach  first,  and 
the  head  perhaps  chiefly  from  its  consent  with 
the  stomach. 


78  Commentaries  on  the 

Very  few  head-achs  are  attended  with  danger; 
but  where  there  is  any,  it  is  found  where  the  most 
and  the  strongest  of  these  symptoms  appear,  (such 
as  stupor,  swelhng  of  the  neck,  dehriousness,  and 
convulsions,)  which  belong  to  epilepsies,  lethar- 
gies, palsies,  and  apoplexies,  into  which  head-achs, 
though  rarely,  have  been  manifestly  continued. 
But  a  head-ach  is  so  common  a  distemper,  and  a 
palsy  so  far  from  being  an  uncommon  one,  and 
yet  the  one  succeeds  the  other  so  seldom,  that 
the  same  person  who  had  been  accustomed  to  the 
former,  may  happen  to  have  the  latter,  without 
affording  sufficient  reason  to  convince  us  that  they 
had  any  connexion  with  one  another.  Some  of 
these  fatal  head-achs,  as  I  have  had  opportunities 
of  knowing,  have  been  occasioned  by  unnatural 
collections  of  liquor,  or  imperfect  suppurations, 
or  morbid  masses  formed  in  the  brain,  which  had 
first  occasioned  the  pain,  and  afterwards  by  the 
increase  of  the  compression  upon  the  origin  of 
the  nerves,  had  at  last  made  them  incapable  of 
performing  any  of  their  duties.  Many  similar 
cases  may  be  found  in  authors,  which  I  forbear  to 
quote,  as  I  propose  to  confine  myself  wholly  to 
the  mention  of  what  has  occurred  in  my  own 
practice,  that  these  remarks  may  have  the  merit 
of  being  copied  immediately  from  nature,  to  make 
up  for  their  other  defects. 

Among  the  more  tractable  head-achs,  the  same 
means,  for  no  obvious  reason,  have  had  such  op- 
posite effects  in  relieving  and  exasperating  similar 
pains,  that  it  must  be  left  to  more  enlightened 
posterity  to  lay  down  a  certain  method  of  cure  ; 
it  not  being  always  easy  at  present  to  satisfy  our- 


History  and  Cure  of  Uiseuses.         7fi 

selves  in  determining  which  is  the  most  probable. 
Anxiety  and  perturbation  of  spirits,  noise,  fatigue 
of  mind  or  body,  too  much  light,  the  air  of"  a  room 
heated  by  a  crowd  of  people,  indigestion,  and  the 
acts  of  sneezing  and  coughing,  have  almost  a  cer- 
tain and  universal  effect  of  making  head-achs 
worse.  Eruptions  upon  the  skin,  eating,  sleep, 
the  heat  of  a  fire,  summer,  winter,  a  cold,  or  hot 
climate,  a  fit  of  the  gout,  and  the  outward  air 
have  had  very  different  effects  upon  different  pa- 
tients ;  but  the  greatest  number  hath  been  bene- 
fited by  sleep,  warmth,  summer,  hot  cHmates,  the 
outward  air,  and  eruptions  appearing  on  the  skin. 
If  cold  bathing,  bleeding  by  leeches,  or  by  open- 
ing a  vein  or  artery,  perpetual  blisters,  issues, 
and  sneezing  powders,  have  done  no  harm,  (of 
which  they  have  been  suspected,)  they  have,  how- 
ever, in  many  cases,  undoubtedly  been  useless, 
and  so  have  warm  bathing,  nervous  medicines  and 
opium.  Though  every  known  remedy  for  head- 
achs  has  at  times  failed,  yet  among  those  which 
have  seldomest  disappointed  my  expectations,  I 
find  a  perpetual  blister  to  the  head,  the  taking 
away  of  six  ounces  of  blood  by  cupping  upon  the 
shoulders  once  in  six  weeks,  and  pills  made  of 
one  grain  of  aloes  and  either  four  grains  of  colum- 
bo-root,  or  half  a  scruple  of  pulv.  myrrh,  comp., 
taken  every  night.  Emetics  are  often  highly  ser- 
viceable ;  the  strain  to  vomit  aggravates  the  pain 
much  less  than  might  be  feared,  and  they  have 
been  repeated  every  month  with  success ;  nor  is 
it  unusual  for  a  spontaneous  vomiting  to  cure  a 
head-ach.  The  pain  of  the  head,  so  common  in 
the  beginning  of  fevers,  is  much  relieved  by  it ; 
but  for  this  particular  head-ach,  a  blister  between 


80  Commentaries  on  the 

the  shoulders  may  be  recommended  as  a  specific. 
Warm  fomentations  of  the  head,  or  feet,  often 
give  present  ease;  and  tinctura  opii  has  been  use- 
tul  for  the  same  purpose. 


CHAPTER  18. 

Capitis  Dolores  intermittentes. 

The  Peruvian  bark  affords  a  remedy  which  sel- 
dom fails  of  curing  periodical  fevers,  in  which  the 
whole  body  seems  to  be  affected  ;  but  in  periodi- 
cal pains  which  seize  only  some  part,  both  this 
bark,  and  every  other  medicine  that  I  know,  often 
prove  ineffectual.  This  is  the  more  to  be  regret- 
ted, because  when  such  a  topical  intermittent  in- 
fests the  head  or  face,  as  it  often  does,  there  is  as 
exquisite  an  anguish  sutJered,  as  from  any  distem- 
per to  which  the  body  is  subject,  if  we  may  judge 
by  the  expressions  of  it,  which  are  wrung  from 
the  most  patient  tempers. 


The  seat  of  these  pains  will  be  the  whole  head, 
as  in  a  common  head-ach,  or  only  the  hind  part, 
or  the  forehead ;  very  frequently  they  will  be  felt 
only  on  one  side  of  the  face ;  and  though  I  have 
known  them  on  both  sides,  and  in  the  same  per- 
son in  different  fits,  yet  they  have  been  much 
more  frequently  on  the  left.  During  the  fit,  the 
upper  lip,  the  gums,  the  cheek,  and  temporal 
muscle,  will  be  in  such  an  agony,  as  to  make  it 
impossible  to  speak,  to  chew,  or  to  swallow ; 
sometimes  only  one  of  these  parts  will  be  affect- 


History  and  Cure  of  Diseases.       81 

ed.  The  mouth  is  filled  with  saliva,  the  eje  wa- 
ters extremely,  and  cannot  bear  the  light ;  the 
eye-lids  will  be  swelled  and  red,  and  I  have  twice 
seen  them  black  and  blue,  from  the  violence  of 
the  pain  in  every  fit.  A  heat  of  the  face,  and 
redness,  with  an  unusual  flow  of  spittle,  have 
been  its  forerunners ;  and  in  some  it  has  been  at- 
tended with  vomiting,  and  little  spasms,  or  tre- 
mors of  the  parts  affected.  The  fits  have  end- 
ed in  one  hour,  and  have  lasted  several,  and  even 
two  days,  and  have  kept  their  periods  as  regular 
as  any  common  quotidian  or  tertian  :  they  have 
also  returned  every  ten  days,  and  once  a  month, 
or  twice  a  year;  but  their  is  usually  great  irregu- 
larity in  the  times  of  their  returning.  In  some 
unhappy  subjects,  this  disorder,  from  being  inter- 
mittent, becomes  almost  continual ;  for  the  slight- 
est attempt  to  eat,  or  speak,  the  motion  of  a  car- 
riage, or  a  blast  of  cold  air,  will  bring  on  the 
pain,  so  that  for  a  considerable  number  of  years 
they  are  scarcely  ever  entirely  free  from  it.  Both 
sexes  are  subject  to  it,  but  women  much  the  most 
so;  and  it  has  spared  no  age,  from  childhood  to 
the  eightieth  year  of  life.  Sometimes  a  stupor 
has  hun«:  on  for  some  hours  after  the  ceasinp-  of 
the  fit ;  but  in  the  intervals  of  the  paroxysms  the 
patients  are  most  usually  free  from  all  complaints. 

In  the  attempts  to  cure  this  malady,  evacuations 
have  proved  not  only  useless,  but  hurtful  ;  and 
bleeding  in  particular  has  been  veiy  detrimental. 
Cataplasms  have  not  been  well  borne,  and  have 
rather  added  to  the  misery  of  the  patients.  The 
Peruvian  bark  has  very  often  been  tried  in  vain, 
and  so  have  the  root  of  valerian,  the  fetid  gums, 
11 


8S  Commentaries  on  the 

myrrh,  musk,  camphor,  opium,  extract  of  hem- 
lock, sneezing  powders,  blisters,  deep  caustics, 
electrifying,  fomentations  made  of  a  decoction  of 
hemlock,  warm  pediluvia,  epithems  of  ether,  ano- 
dyne balsam,  sp.  vini,  linimentum,  saponaceum, 
and  oil  of  amber,  opening  the  temporal  artery, 
and  drawing  some  of  the  teeth ;  nor  has  a  super- 
vening fit  of  the  gout  made  any  alteration  in  this 
obstinate  ailment.  But  still  the  bark  has  now  and 
then  succeeded,  and  not  so  seldom  but  that  it  is 
advisable  to  recommend  it  in  the  first  place ;  an 
ounce  of  it,  or  not  much  less,  should  be  given  eve- 
ry day  for  a  week.  Blisters  behind  the  ears  have 
appeared  to  abate  the  violence  of  the  fits ;  and  in- 
stances have  not  been  wanting  of  the  good  effect 
of  as  much  extract,  cicutae  given  daily  as  could 
be  borne  without  giddiness.  In  some  cases,  where 
every  thing  else  had  failed,  a  draught  with  one 
quarter  of  a  grain  of  emetic  tartar  and  forty  drops 
of  tincture  of  opium,  taken  at  bed-time  for  six 
nights,  has  made  a  lasting  cure.  Cold  bathing 
has  also  been  used  with  benefit.  If  the  patient 
be  unable  to  swallow  the  bark,  or  very  averse 
from  taking  it,  six  ounces  of  a  strong  decoction 
with  a  quarter  of  an  ounce  of  the  powder  may  be 
given  in  a  clyster,  to  which,  if  there  be  occasion, 
tinct.  opii  may  commodlously  be  added. 


CHAPTER  19. 

Carbuncle 

Is  a  large  red  tutnour,  usually  appearing  in 
the  back,  with  a  spongy  base,  loaded  with  a  pu- 


History  and  Cure  of  Diseases.         83 

rulent  liquor,  oozing  out  plentifully  at  any  cracks 
or  openings  which  it  finds.  Soon  after  the  tu- 
mour begins,  there  comes  on  a  considerable  de- 
gree of  fever,  with  great  inquietude,  and  loss  of 
strength,  of  appetite,  sleep,  and  flesh;  so  that  it 
has  many  marks  of  being  the  cause  or  effect  of 
some  extraordinary  derangement  of  the  health. 
Old  persons  and  shattered  constitutions  are  the 
usual  subjects  of  this  malady.  The  notion  of  its 
being  commonly  attended  with  a  diabetes,  has  by 
no  means  been  confirmed  by  my  experience.  In 
some  cases,  I  have  remarked  only  the  usual  quan- 
tity of  urine,  and  that  generally  with  a  sediment ; 
and  in  one  there  was  a  total  suppression  of  it  for 
two  days  before  the  patient's  death.  Among 
those  carbuncles  which  I  have  seen,  several  have 
proved  fatal.  As  much  bark  should  be  given  as 
the  patient  can  take  without  loathing ;  and  as 
m'lch  of  an  opiate  as  the  inquietude  and  want  of 
sleep  may  require. 


CHAPTER  20. 

Chorea  Sancti   Viti* 

The  subjects  of  St.  Vitus's  dance  are  chiefly 
children  from  the  age  of  ten  to  fifteen  years,  it 
has  come  on  so  early  as  the  sixth  year,  and  so 
late  as  in  the  twentieth.  Among  the  patients 
whom  I  have  attended,  there  have  been  four  times 
as  many  girls  as  boys.  Their  legs  and  arms  are 
agitated  involuntarily,  but  the  arms  more  than 
the  legs ;  and  it  is  in  a  very  imperfect  and  awk- 


84  Commentaries  on  the 

ward  manner  that  they  perform  any  spontaneous 
motion.  One  side  usually  suffers  more  than  the 
other,  as  in  the  hemiplegia ;  but  the  disease  does 
not  always  keep  constantly  in  the  same  person  to 
the  same  side.  Some  weakness,  and  cramps,  and 
such  slight  symptoms  of  it,  have  usually  been  ob- 
served for  some  little  time,  and  they  have  been 
known  to  continue  for  several  months  before  the 
distemper  was  fully  formed  :  it  has  also  been 
brought  on  suddenly  by  convulsions  :  in  many  it 
has  been  preceded  by  a  stiffness  and  pains  of  the 
knees.  The  tongue  is  so  much  affected,  that 
none  of  these  patients  can  speak  plainly  :  several 
can  hardly  speak  intelligibly,  and  some  wholly 
lose  all  power  of  speaking  at  all.  A  boy  had  his 
legs  so  violently  agitated,  that  the  involuntary 
motions  overpowered  all  the  weaker  efforts  of  his 
will  to  move  them ;  but  a  stronger  exertion  of  the 
power  which  excites  spontaneous  motions  \vi.s 
able  to  controul  his  distempered  agitations,  so 
that  he  could  run,  but  could  not  walk  :  the  same 
is  observable  in  men  intoxicated  to  a  certain  de- 
gree with  strong  liquors. 

This  singular  species  of  convulsions  is  accom- 
panied with  giddiness,  numbnesses,  uneasiness  of 
the  stomach,  disturbed  sleep,  and  wasting  of  the 
flesh,  though  without  much  loss  of  appetite ;  and 
for  a  time  the  understanding  and  temper  become 
more  childish.  This  malady  is  hardly  ever  fatal 
to  the  patients ;  but  is  seldom  removed  in  less 
than  a  month,  and  often  resists  all  remedies  for 
two  or  three,  and  has  been  known  to  last  a  year. 
A  relapse  is  uncommon  ;  yet  in  some  few,  after 
they  have  seemingly  recovered  from  this  disease, 


History  and  Cure  of  Diseases.  85 

there  has  been  felt  a  little  tendency  to  it  every 
spring  and  autumn  for  three  or  four  years.  A 
violent  affection  of  the  mind  has  also  made  some 
symptoms  of  it  return,  so  that  slight  traces  of  the 
agitations  have  been  perceived  for  ten  years ;  if 
they  were  not  rather  hysteric,  or  paralytic  com-, 
plaints,  to  which  St.  Vitus's  dance  is  nearly  al- 
lied. 

Nor  does  it  seem  more  allied  to  them  by  the 
appearance  of  its  symptoms,  than  by  the  cure 
"which  it  requires.  Bleeding,  and  pui'ging,  and 
violent  medicines,  can  hardly  be  judged  proper 
for  a  distemper  attended  with  no  inflammation, 
nor  heat,  and  particularly  incident  to  a  very  ten- 
der age,  and  to  the  weaker  sex  ,•  and  which,  if  left 
entirely  to  itself,  would,  I  believe,  generally  cease 
spontaneously,  and  leave  the  constitution  unhurt. 
This  reasoning  appears  to  me  to  have  been  justi- 
fied by  fact  aud  experience.  Where  they  have 
been  used,  I  never  saw  any  good  effects  from 
them,  and  rather  suspect  that  they  have  done 
mischief.  Pulv.  myrrhae  comp.  gr.  v.  pil.  opii  gr. 
ij.  made  into  two  pills  to  be  taken  at  bed-time 
every  night,  eccoprotics  used  occasionally,  so  as 
just  to  prevent  costiveness,  and  a  cup  of  any  mild 
bitter  infusion  taken  once  or  twice  a  day,  is  the 
method  which  has  succeeded  best  with  me  :  to 
which,  when  the  patients  begin  to  recover,  the 
cold  bath  may  be  advantageously  joined,  in  order 
more  expeditiously  and  perfectly  to  restore  their 
strength.  I  have  known  it  borne  extremely  well 
in  the  very  worst  state  of  this  malady. 


86  Commentaries  on  the 

CHAPTER   21. 

Coxce  Morbus  et  Exulceratio. 

There  is  a  disease  near  the  hip  very  different 
from  the  sciatica,  or  rheumatism,  of  that  part; 
and  though  less  painful,  it  occasions  greater  lame- 
ness, and  is  far  more  dangerous.  It  is  seated  in 
the  joint  of  the  thigh,  and  is  attended  with  a  re- 
markable pain  in  the  knee,  but  with  scarcely  any 
in  the  part  affected,  even  after  the  swelling  is  be- 
come very  great,  and  a  fluctuation  of  matter  is 
perceivable.  The  thigh  wastes,  and  the  foot  of 
that  side  is  unable  to  support  any  share  of  the 
weight  of  the  body.  The  patients  sometimes  die 
hectic,  and  wasted,  before  the  swelling  either 
breaks  or  is  opened,  but  more  commonly  the  ul- 
cer of  the  joint  makes  a  way  for  the  purulent 
matter  to  discharge  itself  outwardly  :  yet  this  sel- 
dom saves  their  lives,  and  never  prevents  their 
lameness. 

This  disease  will  in  some  go  on  increasing  for 
three  years  before  it  becomes  fatal.  It  is  chiefly 
found  from  the  sixth  to  the  sixteenth  year,  during 
which  time  of  life  the  joints  and  external  parts  of 
the  body  suffer  most  from  scrofulous  complaints  ; 
w^hich,  after  this  age,  seem  to  be  turned  upon  the 
lungs,  or  abdominal  viscera.  The  hip-evil  evi- 
dently belongs  to  the  scrofula ;  and  other  scrofu- 
lous appearances  are  often  joined  with  it.  The 
Peruvian  bark,  and  cicuta,  opium,  and  eccopro- 
tics,  make  up  the  whole  of  the  medicines,  which 


History  and  Cure  of  Diseases,         87 

either  aim  at  the  cure,  or  can  occasionally  relieve 
this  most  difficult  and  dangerous  distemper. 


CHAPTER  22. 

Crurum  Dolor^  Tumor^  Inflammation  et  Ulcus, 

Beside  rheumatic  and  arthritic  pains,  with  con- 
sequent weakness,  almost  to  a  loss  of  their  use, 
which  the  legs  suflfer  in  common  with  other  parts 
of  the  body,  they  are  peculiarly  subject  to  oede- 
matous  swellings  without  any  pain ;  secondly  to  a 
sharp  humour,  which  swells  and  thickens,  and 
hardens  the  skin,  with  an  intolerable  itching; 
which  sharp  humour  oozes  out  copiously  through 
cracks,  where  the  skin  has  either  burst,  or  has 
been  torn  by  rubbing  and  scratching  to  allay  the 
violence  of  the  itching :  thirdly,  to  erysipelatous 
inflammations  with  great  pain,  which  return  upon 
some  persons  once  or  twice  every  year,  being 
preceded  by  shiverings  and  a  hot  fit,  like  an  ague. 
This  inflammation  continues  troublesome  for  seve- 
ral days  at  least,  and  will  often  end  in  an  obsti- 
nate and  ill-conditioned  ulcer,  which  no  art  can 
heal  for  many  years. 

These  disorders  are  not  always  owing  to  inter- 
nal causes,  but  have  sometimes  appeared  in  con- 
sequence of  external  hurts  of  the  legs,  by  which 
they  have  been  weakened,  or  otherwise  injured. 
Women  are  far  more  subject  to  all  these  diseases 
of  the  legs  than  men  (except  perhaps  that  erysi- 
pelatous inflammation,  which  lasts  only  a  few  days 


88  Commentaries  on  the 

or  weeks.)  Healthy  young  women  will  often 
have  their  legs  swell  oedeinatousiy,  especially  in 
hot  weather,  which  never  happens  to  the  young 
and  healthy  of  the  other  sex.  Pregnancy  rarely 
fails  to  occasion  this  sort  of  swelling.  A  redness 
of  the  whole  leg,  with  the  skin  thickened  and 
hardened,  and  itching  insufferably,  with  a  great 
discharge  of  a  sharp  water,  is  very  common 
among  women  after  their  fortieth  year,  remaining 
incurable  for  several  years ;  with  which  com- 
plaints fewer  men  are  molested ;  and  the  same 
may  be  said  of  ulcers  of  the  legs. 

If  then  these  swellings  and  inflammations,  and 
ulcers,  be  almost  peculiar  to  the  legs,  and  chiefly 
incident  to  those,  who  from  their  age,  or  sex,  or 
accidental  hurts,  may  reasonable  be  supposed  to 
have  less  firmness  either  in  the  textures  of  their 
whole  bodies,  or  of  this  particular  part,  it  should 
seem  a  right  practice  to  add  an  additional  strength 
by  bandages  and  straight  stockings :  and  how 
safely  this  may  be  done  appears  from  the  total 
vanishing  of  the  tumour  by  a  horizontal  posture, 
without  any  apparent  injury  to  the  health;  and 
from  the  ready  healing  of  the  inflammations  and 
ulcers  in  many  cases,  where  they  were  probably 
occasioned  by  weakness. 

But  it  undoubtedly  happens  that  the  morbid 
quantity,  or  quality  of  the  humours,  are  no  uncom- 
mon causes  of  the  swellings  and  sores,  which 
therefore  cannot  safely  be  repelled  by  violent 
means.  An  asthma,  probably  arising  froD)  water 
in  the  breast,  which  threatened  every  moment  to 
be  fatal,  has  immediately  taken  a  more  favourable 


History  and  Cure  of  Diseases,       89 

turn  as  soon  as  the  lower  parts  of  the  body  began 
to  swell ;  and  a  sense  of  internal  heats,  with  ruany 
disorders  of  the  stomach,  and  other  parts,  have 
found  as  great  relief  by  the  formation  of  an  ulcer 
in  the  leg;  on  the  other  hand,  the  healing  of  an 
ulcer  in  this  part,  has  been  followed  by  head-achs, 
giddiness,  numbnesses,  shortness  of  breath,  loss 
of  appetite,  and  pains  of  the  stomach  and  bowels. 
A  due  attention  to  the  present  habit  of  the  pa- 
tient's body,  and  to  his  former  state  of  health, 
will  afford  the  best  direction  to  the  physician's 
judgment  in  deciding,  whether  it  be  safe  to  cure 
these  disorders,  or  necessary  to  let  the  present 
evil  remain,  in  order  to  prevent  a  greater. 

The  Rochelle,  or  any  other  of  the  purging 
salts,  given  twice  or  three  times  a  week,  so  as  to 
purge  not  more  than  thrice;  two  scruples  of  the 
Peruvian  bark  taken  every  day  at  any  convenient 
hour;  and,  if  there  be  occasion  for  any  thing  fur- 
ther, a  quarter  or  a  third  or  part  or  half  a  grain 
of  calcined  mercury,  with  a  scruple  of  crude  anti- 
mony swallowed  every  night,  or  every  other 
night,  will  perhaps  answer  all  the  purposes  of 
evacuating  and  correcting  the  morbid  humours. 
They  may  be  continued,  if  they  be  so  long  want- 
ed, for  two  or  three  months.  An  issue  above  the 
knee  has  been  judged  to  contribute  sometimes  to 
the  cure  or  prevention  of  an  ulcer  in  the  leg;  and 
in  other  cases  it  has  been  useless. 


12 


90  Commentaries  on  the 

CHAPTER  23. 

Cutis   Vitia, 

There  is  a  great  variety  of  cutaneous  disor- 
ders. The  several  discolourings  of  the  skin, 
brown,  yellovr,  black,  and  blue,  hardly  deserve 
to  be  reckoned  among  its  diseases,  where  they 
neither  rise  above  the  level  of  the  other  parts, 
nor  are  attended  with  any  unusual  sensations.  It 
may  however  be  worth  the  mentioning,  that  I 
have  seen  some  children  with  little  purple  spots, 
like  the  purples  in  bad  fevers,  all  over  their  bo- 
dies, except  that  in  some  places  there  were  larger 
patches  of  them  as  broad  as  the  palm  of  ^he  hand, 
unaccompanied  with  fever  or  any  other  alteration 
of  their  health,  which  after  a  few  days  sponta- 
neously vanished.*  In  old  people,  blue  spots, 
about  a  quarter  of  an  inch  broad,  are  not  uncom- 
mon. 

Small  pimples  frequently  rise,  and  soon  die 
away  without  spreading ;  but  they  sometimes 
spread  into  a  branny,  or  scaly  blotch,  or  turn  to 
a  thick  crust,  cracking  in  various  places ;  whence 
a  water  oozes  out,  with  which  the  legs  and  face, 
and  more  rarely  the  whole  body,  are  covered, 
with  equal  deformity  and  inconvenience.  Erup- 
tions, or  risings  above  the  skin,  are  red,  or  of  the 
same  colour  with  the  skin,  moist  or  dry,  watery 
or  purulent,  smarting  or  itching,  and  sometimes 
without  either.     The  nails  too  will  become  rough 

*  See  chapter  78. 


History  and  Cure  of  Diseases,         91 

and  thick  and  scaly.  Pustules  will  arise  so  large 
as  to  approach  the  size  of  biles,  which  they  re- 
semble. A  heap  of  small  watery  pimples,  after 
they  have  broken,  have  been  known  to  leave  a 
speck  of  blood,  like  the  point  of  a  pin,  with  itch- 
ing and  swelling. 

Several  of  the  appearances  here  mentioned 
have  been  distinguished  among  the  ancient  physi- 
cians by  peculiar  names  :  there  is  great  difficulty, 
though  happily  not  much  use,  in  ascertaining  the 
appearances  to  which  these  names  were  appro- 
priated ;  for  this  reason  the  ancient  divisions  and 
titles  of  cutaneous  diseases  are  very  little  regard- 
ed by  the  moderns.  Almost  all  affections  of  the 
skin,  which  have  no  other  name,  are  vulgarly, 
with  great  impropriety,  called  the  scurvy.  Of 
the  true  scurvy  and  leprosy  I  can  say  nothing,  as 
they  have  never  occurred  in  my  practice  ;  beside 
these,  the  itch,  shingles,  and  scald-head,  are  per- 
haps the  only  chronical  cutaneous  ails,  for  which 
we  have  names,  in  which  all  are  agreed. 

Several  of  these  maladies  are  hereditary :  and 
even  where  they  are  not  derived  from  the  parents, 
they  may  still  be  the  effects  of  a  general  disorder 
of  the  body,  rather  than  merely  local,  and  belong- 
ing only  to  the  skin.  Cutaneous  ails,  brought  by 
some  children  with  them  into  the  world,  have 
continued  with  very  little  interruption  to  the  end 
of  a  long  life.  After  the  measles  and  small  pox, 
disorders  of  the  skin  will  make  their  appearance 
in  some,  who  never  had  any  of  them  before  :  it 
remains  a  doubt,  whether  they  have  been  formed 
by  some  mischief  arising  from  these  diseases,  or 


9S  Commentaries  on  the 

whether  they  have  ^nlj  been  excited  from  latent 
seeds  pre-existing  in  the  body  ;  or  lastly,  whether 
their  appearance  at  that  time  be  not  wholly  casu- 
al :  since  it  happens  more  seldom,  than  it  proba- 
bly would,  if  the  small  pox  and  measles  had  a  na- 
tural tendency  either  to  breed  any  diseases  in  the 
skin,  or  to  nourish  them. 

The  spring  of  the  year  is  the  season  in  which 
they  are  most  apt  to  appear,  or  to  grow  worse  ; 
and  next  to  this  may  be  reckoned  the  autumn  ; 
but  this  is  by  no  means  constant.  There  is  still 
much  greater  uncertainty  with  regard  to  summer 
and  wmter ;  so  that  it  is  hard  to  say  whether 
more  diseases  of  the  skin  be  exasperated,  or  re- 
lieved, by  either  of  them.  The  warmth  of  a  bed, 
and  of  a  fire,  has  made  some  spots  of  the  skin  re- 
treat, which  never  failed  to  re-appear  in  propor- 
tion as  the  body  was  cooled  ;  the  contrary  to  this 
has  been  experienced  in  several  instances,  and 
perhaps  in  more. 

A  moisture  behind  the  ears  is  common  in  chil- 
dren ;  and  this,  whether  from  neglect  of  keeping 
the  part  clean,  or  from  the  abundance  and  sharp- 
ness of  the  humour,  will  sometimes  spread  all 
over  the  head  and  face.  The  branny  scurf, 
which  is  often  observed  in  several  patches  all 
over  the  body,  is  very  apt  to  begin  at  the  point 
of  the  elbow.  A  violent  itching  of  the  skin  with- 
out any  eruption  is  familiar  to  the  jaundice,  and 
adds  sometimes  to  the  discomforts  of  old  age.* 
Several   women   have   had   a   pimple   appear   on 

*See  afterwards  chapter  76. 


ii 


^History  and  Cure  of  Diseases.  93 

their  noses,  which  has  been  succeeded  by  a  thick 
scab,  covering  by  degrees,  the  nose,  face,  and 
neck;  and  has  for  many  years  eluded  every 
method  of  cure  w^hich  a  variety  of  physicians  was 
able  to  suggest.  This  appearance  is  much  less 
common,  though  not  altogether  unknown,  in  the 
other  sex.  A  branny  scurf  in  various  parts  of  the 
skin,  and  particularly  in  the  head,  has  infested 
some  through  their  whole  lives. 

There  seems  to  be  very  little  if  any  contagion 
in  cutaneous  disorders,  if  we  except  the  itch  and 
scald  head.  A  woman,  who  had  for  five  years 
had  broad  branny  eruptions,  suckled  a  child  whose 
skin  remained  perfectly  clear  from  any  disorder. 
The  itch  is  well  known  to  be  very  infectious  ;  but 
there  is  an  appearance  exactly  like  it,  and  which 
could  be  traced  up  to  its  having  been  received 
from  an  infected  person,  and  yet  differs  from  the 
true  psora  by  being  very  little,  if  at  all  infectious, 
by  its  resisting  all  the  usual  remedies,  and  by  its 
returning  frequently  for  many  years.  While  the 
ears  are  swelled  and  red  with  a  great  watery  dis- 
charge from  behind  them,  it  is  very  common  for 
the  lymphatic  glands  to  be  swelled,  as  they  often 
are  for  a  few  days  after  a  considerable  discharge 
has  been  procured  from  the  neighbouring  parts 
by  a  blister. 

Many  morbid  appearances  of  the  skin  are  judg- 
ed to  be  proofs  of  a  diseased  constitution,  rather 
than  merely  local  disorders  of  the  part  which  is 
afflicted  with  them  ;  yet  in  some  instances  a  hurt 
of  the  skin  by  a  bruise  or  a  burn  has  been  the 
cause  of  a  general  mischief;  so  that  in  consequence 


94  Commentaries  on  the 

of  such  an  accident  a  clear  habit  of  body  has  in 
an  advanced  age  of  hfe  shewn  all  the  marks  of 
what  is  vulgarij  called  a  scorbutic  or  even  stru- 
mous taint.  There  are  also  other  instances  where 
cutaneous  maladies,  instead  of  relieving,  have  al- 
ways hurt  the  general  health,  never  failing  to  be 
accompanied  with  head-achs  and  languors,  which 
increased  and  decreased  with  the  eruptions.  Such 
cases  however  are  rare  ;  and  the  reverse  is  much 
oftener  met  with,  where  some  general  ail  of  the 
body  throws  itself  off  in  blotches  and  deformities 
of  the  skin  ;  so  that  when  these  retreat  of  them- 
selves, or  are  repelled,  the  patient  will  complain 
of  head-achs,  giddiness,  lowness  of  spirits,  want 
of  sleep,  cough,  want  of  appetite,  heart-burn,  fla- 
tulence, sickness,  pains  of  the  stomach,  wandering 
pains,  feverishness,  and  wasting  of  the  flesh.  It 
is  a  doubt,  whether  some  asthmatic,  consumptive, 
and  paralytic  complaints,  have  been  the  effect  of 
cutaneous  distempers  ceasing  to  appear,  or  whe- 
ther both  of  them  have  been  owing  to  some  com- 
mon cause ;  for  it  has  been  not  improbable,  that 
some  fatal  mischief  arising  from  other  causes  had 
so  weakened  the  powers  of  life,  that  nature  was 
unable  to  free  herself  any  longer  from  that  in- 
cumbrance which  she  used  to  throw  off  upon  the 
skin. 

The  moistur;'^^  so  common  behind  the  ears  of 
children,  during  the  first  four  years  of  their  lives, 
requires  only  to  have  the  parts  kept  Clean  with  a 
little  warm  water,  and  to  be  hindered  from  grow- 
ing together  by  means  of  a  fine  rag  smeared  with 
any  mild  ointment ;  but  all  further  application 
should  be  avoided,  as  having  been  sometimes  at- 


I 


History  and  Cure  of  Diseases.  95 

tended  with  convulsive  fits,  shortness  of  breath, 
and  other  bad  consequences ;  whereas  none  need 
be  feared  from  suffering  the  disorder  to  take  its 
own  course,  and  from  trusting  to  its  curing  itself, 
as  soon  as  it  is  for  the  patient's  benefit  that 
it  should  be  cured.  Where  mischief  has  ensued 
from  repelling  these  eruptions  in  children  by  vio- 
lent means,  a  slight  anointing  of  the  parts,  which 
had  been  affected,  with  the  blister  ointment,  will 
be  an  useful  method  of  recalling  them. 

In  adults  there  is  usually  less  danger,  than  dif- 
ficulty, in  freeing  the  skin  from  the  several  ble- 
mishes to  which  it  is  liable.  There  are  too  many 
so  deeply  rooted  in  the  constitution,  as  to  elude 
all  the  known  external  and  internal  remedies ; 
and  they  are  often  supposed  to  be  cured  when 
they  are  not ;  for  it  is  hard  to  determine  whether 
they  have  yielded  to  the  remedies,  or  have  spon- 
taneously retreated  ;  which  they  have  been  known 
to  do,  and  to  be  latent  for  aJDove  twenty  years, 
after  which  they  have  returned  with  unabated  vi- 
gour ;  plainly  shewing  that  the  cause  had  been 
neither  subdued  nor  weakened.  Where  the  per- 
spiration is  great,  and  confined,  as  in  the  groin, 
under  the  breasts  of  women,  and  in  the  necks  and 
other  parts  of  very  fat  children,  it  is  apt  to  grow 
acrid,  and  to  fret  the  parts  on  which  it  lies ;  the 
frequent  washing  of  them,  and  the  use  of  any  soft 
ointment  to  prevent  their  rubbing  against  one  an- 
other, will  prove  effectual  remedies.  During 
pregnancy  many  obstinate  cutaneous  maladies 
have  been  known  to  disappear  spontaneously, 
which  had  long  resisted  all  the  usual  medicines; 
^  but  after  delivery  they  have  returned  in  their  for- 


,96  Commentaries  on  the 

mer  manner.  There  has  been  reason  to  believe 
that  issues  and  blisters  have  in  several  instances 
proved  useful  drains  to  those  morbid  humours 
which  made  the  skin  foul  and  unsightly;  but  in 
others  no  benefit  has  seemed  to  arise  from  them. 

With  regard  to  external  applications,  it  is  an 
useful  general  rule  to  employ  acrid  washes  and 
unguents,  where  the  diseased  skin  is  accompanied 
with  itching ;  but  where  it  is  attended  with  sore- 
ness and  pain,  to  use  such  mild  ones  as  may  miti- 
gate rather  than  increase  the  smart;  otherwise, 
troublesome  and  even  dangerous  inflammations 
might  be  brought  on.  Water  is  the  gentlest  oi  all 
external  remedies,  whether  it  be  made  a  cold  or 
warm  bath,  or  applied  in  fomentation  and  vapour. 
It  dilutes  and  weakens  any  sharp  moisture  which, 
by  fretting  the  skin,  may  increase  the  evil ;  and 
by  suppleing  the  scales  and  crusts,  makes  them 
more  easily  thrown  off.  Salt,  sulphur,  and  vari- 
ous herbs,  are  sometimes  added  to  improve  its 
detersive  powers ;  hence  the  sea  water,  and  many 
natural  springs,  are  judged  more  efficacious  than 
plain  water.  Preparations  of  lead,  though  void 
of  all  acrimony,  are  in  such  general  esteem  as  ex- 
ternal cutaneous  remedies,  that  they  are  not  only 
used  to  the  disorders  attended  with  heat  and  some 
degree  of  pain,  but  also  to  such  as  only  itch,  or 
are  perfectly  indolent.  Extracts  of  lead  made 
with  vinegar,  ceruse,  and  sugar  of  lead,  formed 
into  washes,  ointments,  and  plaisters,  are  all  in 
frequent  use ;  and  it  is  not  easy,  from  any  experi- 
ence which  I  have  had  of  them,  to  say  which  of 
these  preparations  is  preferable  to  the  others. 
The  tar  ointment  may  likewise  be  applied  not^ 


History  and  Cure  of  Diseases.        97 

only  to  such  blotches  as  itch,  but  even  to  those 
where  there  are  cracks  and  moist  sores,  without 
any  fear  of  increasing  the  pain  in  most  cases  ;  but 
in  a  few  instances  it  has  been  known  to  dry,  and 
create  pain.  Sulphur  has  a  specific  virtue  in  cur- 
ing one  distemper  of  the  skin,  and  there  are  few 
others  in  which  it  has  not  been  tried  externally 
and  internally.  The  success,  whatever  it  may 
have  been,  has  by  no  means  been  so  great  as  to 
hinder  our  doubting  whether  it  have  any,  except 
in  curing  the  itch.  Tiie  seeds  of  staves-acre, 
and  the  root  of  white  hellebore,  are  both  extreme- 
ly acrid,  and  require  so  much  caution  and  accura- 
cy in  the  dose,  that  they  have  very  rarely  been 
ventured  upon  as  internal  medicines  ;  but  when 
applied  outwardly,  they  are  safe  and  effectual  in 
a  degree,  which  may  make  it  probable  that,  be- 
sides their  acrimony,  they  have  some  specific 
powers  in  clearing  the  skin  from  foulnesses.  One 
grain  of  white  hellebore  may  be  safely  given  in- 
ternally, but  I  know  nothing  of  the  internal  use 
of  staves-acre  :  half  an  ounce  of  the  seeds  of 
staves-acre,  powdered,  may  be  infused  in  half  a 
pint  of  boiling  water,  to  which,  after  it  is  cold, 
should  be  added  as  much  brandy,  and  the  parts 
affected  are  to  be  washed  morning  and  night  with 
the  strained  liquor.  A  lotion,  applicable  in  the 
same  manner,  may  be  made  by  pouring  twenty 
ounces  of  boiling  water  upon  four  or  six  drams  of 
the  powder  of  white  hellebore  root,  and  by  ad- 
ding to  the  strained  liquor  four  ounces  of  the  tinc- 
ture of  the  same  root.  The  only  ill  effects  of 
I  which  I  am  aware  from  these  lotions  is  the  pain 
and  constant  inflammation  which  they  may  occa- 
sion ;   this   will   easily   be   remedied  by  lowering 


I 


98  Gomnientarles  on  the 

them  with  more  water,  till  the  heat  and  pain  be- 
come moderate.  There  is  such  a  difference  of 
soundness  and  freshness  in  different  parcels  of 
these  drugs,  that  there  is  no  other  way  of  exactly 
proportioning  the  quantity  of  water  but  by  some 
help  from  trial ;  not  to  mention  the  various  de- 
grees of  sensibility  which  is  to  be  found  in  the 
skins  of  different  persons.  They  may  also  be 
used  in  ointments,  by  mixing  them  with  four  times 
their  quantity  of  simple  ointment.  Pepper,  and 
many  other  acrimonious  simples,  have  a  place 
likewise  among  cutaneous  remedies :  upon  this 
account  cantharides  in  ointments  and  plasters  have 
been  used  to  clear  the  skin  from  its  diseases;  but 
I  have  not  been  witness  to  their  virtues  for  this 
purpose  often  enough  to  be  sufficiently  acquainted 
with  them.  Solutions  of  alum,  and  of  vitriol,  will 
allay  a  troublesome  itching  of  the  skin  which 
comes  without  an  eruption,  and  will  also  destroy 
the  half-dead  scales,  and  clear  the  skin  from  seve- 
ral blemishes.  The  strength  of  these  solutions 
must  be  limited  by  the  pain  and  inflammation 
which  they  occasion  :  while  these  are  slight,  they 
can  never  be  too  strong.  The  same  rule  holds 
with  regard  to  all  the  otlier  acrimonious  remedie? 
for  the  skin. 

Quicksilver,  besides  the  corrosiveness  of  its 
preparations,  appears  to  have  some  peculiar  pow- 
ers in  destroying  the  causes  of  some  cutaneous 
maladies.  Crude  quicksilver,  which  is  perfectly 
mild  to  the  touch,  when  divided  with  any  tena- 
cious substance,  and  applied  in  ointments  and  plas- 
ters, has  been  found  considerably  efficacious  in 
cleansing  the  skin  from  many  foulnesses.     The 


History  and  Cure  of  Diseases.         99 

chemical  preparations  of  it  add  greatl-y  to  its  pow- 
ers, by  tne  degree  of  acrioiony  which  thej  pos- 
sess. The  neatest  of  all  these,  but  at  the  same 
time  the  most  violent,  is  the  corrosive  sublimate, 
because  it  perfectly  dissolves  in  water,  or  spirits 
of  wine,  and  has  neither  colour  nor  smell.  The 
others,  being  indissoluble  in  water,  must  be  appli- 
ed in  unguents  and  plasters.  It  must  always  be 
remembered,  that  besides  the  caution  necessary 
to  prevent  pain  and  inflammation  from  thtf  more 
acrimonious  preparations  of  mercury,  there  is  an- 
other thing  to  be  attended  to  in  the  use  of  all  of 
them,  which  is,  not  to  employ  them  in  so  large  a 
quantity  as  to  occasion  their  peculiar  effect  of  sa- 
livating. One  dram  of  corrosive  sublimate  will 
generally  be  sufficient  for  a  pint  of  water  ;  half  an 
ounce  is  much  loo  large  a  quantity  ;  and  I  have 
known  great  pain  and  swelling  ensue  from  wash- 
ing a  very  small  portion  of  the  skin  with  so  strong 
a  mercurial  lotion.  The  corrosive  sublimate 
should  be  dissolved  in  pure  water  preferably  to 
lime  water,  which  only  weakens  it,  and  gives  it  a 
disagreeable  yellow  colour.  With  regard  to  the 
probability  of  exciting  a  salivation,  there  will  be  a 
great  difference,  arising  from  the  largeness  of  the 
surface  of  the  body  to  which  the  mercurial  medi- 
cine is  applied.  A  very  weak  preparation  spread 
over  a  large  portion  of  the  body,  would  be  much 
more  likely  to  raise  a  salivation,  than  a  much 
stronger  which  covered  only  a  small  part  of  it. 
The  ungueutum  hydrargyri  nitrati  has  been  anoint- 
ed over  the  whole  face  every  day  for  many  days 
together,  without  any  complaints  either  of  present 
pain,  or  consequent  salivation.  How  innocent  a 
mercurial  ointment  may  be  made  with  one  dram 


100  Commentaries  on  the 

of  the  calx  hydrargyri  alba  and  one  ounce,  or 
half  an  ounce,  of  simple  ointment,  may  be  judged 
from  the  free  use  which  is  safely  made  in  surgery 
of  that  stronger  preparation,  mercurius  nitratus 
ruber.  Magistery  of  bismuth,  and  flowers  of 
zinc,  either  sprinkled  upon  the  skin,  or  formed 
into  an  ointment,  are  rather  cosmetic,  than  reme- 
dies for  any  harm  considerable  enough  to  be  call- 
ed a  distemper. 

The  internal  medicines  are  either  such  as  eva- 
cuate the  diseased  tumours  or  correct  them. — • 
Strong  purges  are  improper  for  the  first  of  these 
purposes,  and  will  sooner  exhaust  the  patient's 
strength  than  expel  the  cause  of  the  distemper.  A 
long  continuance  of  the  gentler  purgatives  is  best 
calculated  t©  suit  the  obstinate  nature  of  the  dis- 
eases of  the  skin.  The  experience  of  mankind 
seems  to  have  settled  in  preferring  the  purging 
salts  as  the  most  safe  and  commodious  medicines 
of  this  class.  They  neither  pall  the  stomach,  nor 
require  confinement ;  and  are  so  far  from  impair- 
ing^ the  strength,  that  weakly  persons  have  grown 
fatter  and  stronger  during  a  twelve-months  daily 
use  of  sea  water.  Whether  they  are  best  taken 
in  sea  water,  or  the  natural  solutions  of  various 
springs,  or  the  artificial  solutions  in  common  wa- 
ter, and  which  of  the  neutral  purging  salts  is  the 
most  friendly  to  the  body,  and  most  powerful 
against  the  distemper,  all  this  seems  to  remain 
undecided  by  any  experience  with  which  I  am  ac- 
quainted. They  should  n4&t  be  given  in  such  a 
dose  as  to  purge  above  twice,  and  during  their 
use  frequent  attention  should  be  given  to  the 
state  of  the   patient's   strength   and  flesh ;   for  if 


History  and  Cure  of  Diseases.      101 

these  begin  to  be  impaired,  the  purging  ought  to 
be  laid  aside. 

A  great  variety  of  internal  remedies  for  cor- 
recting the  unhealthy  humours  which  shew  them- 
selves upon  the  skin,  are  to  be  found  in  all  prac- 
tical books  of  physic.  Among  all  these  the  Pe- 
ruvian bark  and  mercurial  preparations  have  ap- 
peared to  me  to  do  the  most  good.  In  the  less 
urgent  cases  a  dram  of  the  powder  of  the  bark 
must  be  taken  once  a  day,  or  two  scruples  twice 
a  day.  for  several  months;  and  I  know  it  may  be 
taken  for  a  very  long  time  with  great  advantage 
to  the  general  health,  besides  its  virtues  in  clear- 
in^j  the  skin.  There  has  been  very  great  reason 
to  believe  that  it  has  mended  the  appetite  and  di- 
gestion, and  prevented  catarrhs.  In  more  violent 
disorders,  a  quarter  of  a  grain  of  calcined  mercu- 
ry has  been  given  every  day  for  three  or  four 
months  with  safety  and  benefit.  A  solution  of 
corrosive  sublimate,  containing  half  a  quarter  of 
a  grain,  may  be  used  in  the  same  manner.  This 
method  of  cure  has,  as  far  as  I  could  judge,  prov- 
ed the  most  successful ;  but  it  will  happen,  I  fear, 
to  all  the  known  methods,  that  they  will  be  found 
too  weak  to  subdue  the  obstinacy  of  some  invete- 
rate cutaneous  diseases. 

The  herpes,  or  shingles,  has  begun  with  a  pain 
which  has  lasted  in  some  for  two  or  three  days 
before  the  eruption  appeared.  It  consists  of  a 
heap  of  watery  bladders,  itching  at  first,  of  which 
there  are  sometimes  so  many  as  nearly  to  sur- 
round the  body,  whence  it  has  its  name  of  shin- 
gles, from  cingulum.     This  eruption  is  now  and 


iO^  Commentaries  on  the 

iben  attended  with  a  fever.  The  bladders  should 
be  opened,  and  the  sharp  serum  let  out,  after 
which  the  parts  may  be  covered  with  a  soft  ce- 
rate, to  defend  them  from  the  rubbing  of  the 
clothes,  for  they  are  sometimes  verj  painful.  It 
seldom  happens  that  these  little  blisters  turn  to 
obstinate  sores,  though  in  old  persons,  and  in  bad 
constitutions,  it  will  be  several  days  before  they 
are  quite  healed.  But  the  greatest  part  of  the 
misery  is  many  times  to  come  after  they  are  per- 
fectly well,  and  the  skin  has  recovered  its  natural 
appearance ;  for  I  have  known  a  most  pungent 
burning  pain  left  in  the  part,  which  has  teazed 
the  patient  for  several  months,  or  even  for  two  or 
three  years  ;  nor  have  t  found  that  any  soothing 
or  opiate  application  ever  gave  much  relief.  The 
uneasy  sensation  which  succeeds  the  herpes  has 
in  some  arisen  only  to  a  torpid  feel.  In  one  per- 
son, in  whom  the  herpes  had  broken  out  near  the 
collar  bone  and  shoulder,  such  an  exquisite  ten- 
derness was  left,  that  he  dreaded  to  move  his 
arm,  and  could  hardly  bear  the  application  of  any 
thing  to  the  part,  though  made  with  the  lightest 
feather  :  he  was  obliged  to  cover  himself  only  with 
a  loose  gown,  having,  when  I  saw  him,  been  una- 
ble for  two  or  three  years  to  put  on  a  coat. 
However,  this  was  the  only  instance  in  which  I 
ever  knew  the  pain  rage  with  such  extraordinary 
violence. 

In  a  woman  more  than  fifty  years  old  the  her- 
pes appeared  upon  the  right  clavicle,  together 
with  fever,  and  pains  throughout  the  whole  right 
arm.  The  eruption  and  fever  continued  some 
weeks ;  but  the  skin  remained  scaly  for  several 


History  and  Cure  of  Diseases.       103 

months,  and  the  whole  arm  became  graduallj 
weaker,  till  it  lost  all  power  of  spontaneous  mo- 
tion ;  and  in  this  state  it  continued  at  least  for 
three  years,  and  probably  for  her  whole  life. 
The  fingers  were  constantly  in  an  involuntary  tre- 
mour. 

The  porrigo,  or  scald  head,  begins  with  little 
spots  of  a  branny  scurf,  which  itch  and  grow 
bald  ;  these  gradually  become  larger  and  more 
numerous,  till  they  cover  the  whole  head,  the 
skin  of  which  will  be  sometimes  so  deeply  affect- 
ed with  the  humour  as  to  be  full  of  moist  sores  or 
scabs.  Children  are  more  subject  to  this  com- 
plaint than  adults,  and  boys  more  than  girls. 
Among  grown  persons,  1  have  seen  several  wo- 
men labouring  under  this  complaint,  and  but  few 
men.  It  is  an  infectious  distemper,  and  readily 
communicable  where  children  use  the  same  combs, 
or  pillows,  or  put  the  same  covering  on  their 
heads  with  the  infected  person,  or  hold  their 
heads  close  to  his ;  but  when  all  these  circum- 
stances are  cautiously  avoided,  I  have  known 
children  live  and  play  together  in  the  same  house, 
and  yet  one  who  had  a  scald  head  did  not  give  it 
to  the  rest. 

In  some  constitutions  it  seems  as  if  certain  dis" 
eased  humours  were  thrown  out  and  appeared  in 
the  form  of  a  scald  head  ;  so  that  a  cough  has  im- 
mediately ceased  upon  its  coming  on,  and  when  it 
retreated  the  breathing  has  become  short  and  la- 
borious. A  species  of  this  disorder  has  broken 
out  during  the  infancy  of  some  women,  and  ha» 
continued  upon  them  to  old  age  without  yielding 


104  Commentaries  cm  the 

to  any  medicines.  There  is  no  little  difficulty  in 
curing  it,  in  children,  though  it  may  have  been  re- 
cently contracted  ;  and  every  one  must  have  heard 
of  such  who  have  been  under  very  skilful  manage- 
ment for  two  or  three  years  without  the  desired 
success. 

The  best  method,  which  I  know,  is  to  cut  off 
the  hair  where  the  distemper  has  spread  over  a 
great  part  of  the  head,  and  to  keep  it  anointed 
with- the  tar  ointment,  covering  it  with  a  hog's 
bladder.  If  it  heal  by  means  of  this  application, 
as  it  often  does,  though  it  may  be  two  or  three 
months  before  it  be  well,  I  then  recommend  the 
head  to  be  wetted  morning  and  evening  with  the 
infusion  of  white  hellebore  root  above  mentioned, 
as  long  as  any  tendency  to  scurf  is  seen.  If  there 
should  be  any  part  of  the  head  where  the  skin  is 
more  deeply  diseased  so  as  to  form  a  sore,  one 
dram  of  the  calx  hydrargyri  alba  mixed  with  half 
an  ounce  of  a  soft  cerate  makes  an  useful  oint- 
ment, some  of  which  spread  upon  a  piece  of  thin 
leather  may  be  applied,  and  renewed  as  often  as 
it  grows  too  dry  to  stick  on  any  longer.  Where 
a  healthy  person  has  manifestly  contracted  this 
distemper  from  others,  I  know  of  no  want  of  any 
internal  medicines. 

The  scabies,  psora,  or  itch,  appears  most  com- 
monly like  very  small  watery  pimples,  but  some- 
times resembles  the  smaller  variolous  pustules, 
having  a  red  base,  and  being  filled  with  a  yellow 
matter.  Both  these  appearances  are  attended 
with  excessive  itching,  and  are  found  chiefly  about 
the  joints,  and  particularly  between  the  fingers ; 


History  and  Cure  of  Diseases.     105 

but  very  remarkably  spare  the  face ;  so  that  I  am 
not  sure  that  I  ever  saw  the  least  marks  of  it 
there,  though  once  or  txvice  I  have  been  in  doubt 
whether  the  face  has  not  some  httle  share  of  it. 
No  distemper  is  more  infections  than  this  :  but  it 
has  before  been  mentioned,  that  there  is  a  species 
of  it,  which  was  at  first  catched  by  infection,  and 
thougli  seemingly  cured  by  the  proper  remedies, 
yet  will  continue  to  return  once  or  twice  every 
year, Without  being  contagious  even  to  those  who 
lie  in  the  same  bed,  and  without  retreating  at  all 
the  sooner  from  the  application  of  any  of  the  usu- 
al remedies. 

The  itch  has  been  imputed  to  certain  animal- 
cules. I  was  told  by  that  very  dextrous  experi- 
menter, and  accurate  observer,  the  late  Mr.  Can- 
ton, that  he  had  looked  for  them,  but  had  never 
been  able  to  satisfy  himself  that  there  were  any. 
I  have  heard  the  same  from  Mr.  Henry  Baker, 
whose  well-known  treatise  upon  the  microscope 
shews  that  no  one  was  better  skilled  in  its  use. 

It  is  observable,  that  of  infectious  distempers, 
some,  like  the  small  pox  or  measles,  can  be  had  but 
once  ;  or  very  seldom  oftener,  as  the  malignant 
sore  throat,  and  hooping-cough ;  or  only  in  parti- 
cular circumstances,  or  certain  constitutions  of 
the  air,  as  the  dysentery,  camp-fever,  and  plague  ; 
but  the  itch  and  the  Venereal  distemper  are  very 
generally  communicable  at  all  times  to  all  persons 
who  come  in  the  way  of  their  contagion.  It  is 
not  easy  to  say  what  would  have  been  the  state 
of  mankind,  if  out  of  the  three  specifics  with 

14 


10(1  Commentaines  on  the 

which  Providence  has  blessed  us,  two  of  them 
had  not  opposed  the  universal  infection  with  which 
these  two  disorders  would  otherwise  have  over- 
spread the  whole  world. 

There  is  a  vulgar  notion  in  some  countries, 
that  the  itch  is  wholesome,  and  that  there  is  dan- 
ger in  curing  it  too  soon  :  this  is  almost  too  ridicu- 
lous to  be  mentioned ;  and  yet  I  believe  there  is 
as  much  foundation  for  it,  as  for  that  more  respec- 
table, because  more  general,  notion  of  the  whole- 
someness  of  the  gout.  The  remedies  for  this  dis- 
temper are  in  the  first  place  sulphur,  which  has  a 
specific  or  peculiar  power  of  curing  it,  and  is  al- 
ways safe,  and  can  never  be  applied  too  soon,  and 
therefore  is  preferable  to  all  others ;  but  it  is  often 
objected  to  on  account  of  its  smell,  and  of  its  be- 
ing less  neat  than  other  remedies.  The  most 
common  way  of  using  it  is  by  mixing  one  part  of 
flowers  of  sulphur  with  four  parts  of  lard,  and 
anointing  the  parts  once  every  twenty-four  hours, 
A  cure  is  by  these  means  usually  eflfected  in  about 
ten  days.  A  shirt  being  lightly  sprinkled  with 
the  flowers  of  sulphur  is  said  to  be  equally  effec- 
tual ;  and  the  late  Mr.  Cheselden  told  me,  that 
the  distemper  would  be  cured  if  the  feet  only 
were  anointed,  without  applying  the  ointment  to 
any  other  parts  of  the  body  which  have  suffered 
from  the  itch. 

Crude  quicksilver  seems  also  to  possess  some 
specific  powers ;  for  if  it  be  divided  by  white  of 
egg,  or  any  tenacious  substance,  and  soaked  up 
by  flannel,  or  if  the  unguentum  hydrargyri  be 
spread  upon  linen  or  leather,  and  worn  round  the 


I 


History  and  Cure  of  Biseases.        107 

body  in  the  form  of  a  girdle,  this  application  will 
frequently  be  successful.  And  jet,  what  is  very 
extraordinary,  it  is  not  uncommon  for  persons  to 
rise  from  a  salivation,  uncured  of  the  itch,  not- 
withstanding their  having  been  constantly  daubed 
with  the  mercurial  ointment  for  a  month  or  six 
weeks.  It  is  doubtful  whether  the  chemical  pre- 
parations of  mercury  prove  remedies  on  account 
of  any  specific  virtue,  or  merely  from  their  corro- 
siveness,  which  reduces  these  little  foul  sores  to  a 
state  of  healing,  just  as  any  other  ill-conditioned 
ulcer  is  brought  on  to  heal  by  similar  means. 
The  neatest  of  all  these  preparations  is  a  solution 
of  one  dram,  or  at  most  two  drams,  of  corrosive 
sublimate  in  one  pint  of  pure  water,  with  which 
the  distempered  parts  may  frequently  be  wetted. 
One  dram  of  white  precipitate  mixed  with  four 
times  its  quantity  of  ointment,  makes  also  a  safe, 
and  not  an  offensive  medicine,  which  may  be  ap- 
plied every  night.  Some  persons  have  complain- 
ed of  lowness  of  spirits,  pains  of  the  bowels,  and 
wandering  pains,  after  being  cured  by  the  help  of 
these  girdles,  washes,  and  ointments,  which  they 
laid  to  the  charge  of  the  mercurial  ingredient. 
But  since  very  few  of  those  who  have  been  cured 
by  the  same  means  have  reason  to  suspect  any 
thing  of  this  kind,  and  since  a  much  freer  use  is 
made  of  mercury  upon  several  other  occasions 
without  any  of  these  ill  consequences,  it  is  most 
probable  that  these  patients  were  mistaken  in  as- 
signing this  cause  of  their  complaints. 

The  root  of  white  hellebore  is  preferred  by 
some,  as  having  no  smell,  being  perfectly  inno- 
cent, and   seldom   failing  of  success.     Medicines 


m 


108  Commentaries  on  the 

prepared  from  it  should  be  made  so  strong  as  to 
occasion  some  smart,  but  no  inflammation  :  this 
will  coQimonlj  be  effected  by  one  part  of  the 
powdered  root  and  eight  parts  of  ointment,  used 
in  the  same  manner  as  the  sulphur  ointment. 
The  decoction  or  infusion  of  the  same  root,  as 
mentioned  above,  will  make  a  wash,  which,  used 
like  the  mercurial  wash,  will  verj  rarely  disapr 
point  the  patient. 


CHAPTER  24. 

Destillatio, 

It  was  necessary  that  the  throat,  and  mouth, 
and  nose,  and  eyes,  should  all  be  kept  in  a  slate 
of  moisture ;  for  which  purpose  a  liquid  is  secret- 
ed from  certain  glands  and  glandular  membranes; 
and  if  this  become  incommodiously  copious,  it  is 
called  a  catarrh  or  defluxion.  This  seems  to 
arise  sometimes  from  a  too  great  weakness  or  re- 
laxation of  the  secreting  organs  ;  and  sometimes 
from  an  abundance  of  superfluous  humour,  which 
nature  can  more  easily  discharge  by  these  out- 
lets ;  or  from  the  acririfiony  of  tlie  liquid,  which 
makes  the  ©yes  tender,  or  irritates  the  nose  to 
perpetual  sneezing,  or  the  trachea  to  coughing 
with  hoarseness,  creating  a  pungent  sensation  in 
the  mouth,  and  making  all  the  parts  sore  over 
which  it  flows.  When  the  catarrh  affects  only 
the  eyes,  or  nostrils,  and  the  cavities  which  open 
into  them,  it  is  not  attended  with  any  cough  ;  but 
if  its  seat  be  in  the  glands  of  the  throat,  then 


History  and  Cure  of  Diseases.       409 

there  will  not  only  be  a  cough  in  the  day-time, 
but  the  defluxion  will  collect  in  such  quantities 
during  the  first  sound  sleep  before  it  wakes  the 
person,  that  at  last  he  starts  up  almost  suffocated, 
and  it  is  with  great  efforts  that  he  clears  the  tra- 
chea so  as  to  recover  the  po\ver  of  breathing  with 
tolerable  ease :  possibly  some  may  have  died  sud- 
denly, having  been  choked  in  this  manner.  A 
sudden  sense  of  suffocation  frequently  attacks 
some  persons,  and  it  is  with  great  and  laborious 
efforts  that  they  save  themselves  from  being  chok-* 
ed.  Is  not  this  affection  a  peculiar  kind  of  con- 
vulsion ?  and  is  not  the  thin  froth  which  they  ex- 
pectorate in  their  struggle  for  breath,  rather  the 
effect,  than  the  cause  of  this  disorder  ? 

If  such  a  catarrh  lasts  only  a  few  days,  it  is 
called  a  cold  in  the  head  ;  but  in  many  it  becomes 
a  chronical  disorder,  and  has  lasted  with  no  long 
intervals  for  several  months,  for  four  years,  or 
every  night  for  ten  years  ;  or  has  returned  peri- 
odically twice  a  month  for  several  years,  or  once 
in  three  weeks.  I  have  known  it  return  in  four 
or  five  persons  annually  in  the  months  of  April, 
May,  June,  or  July,  and  last  a  month  with  great 
violence.  In  one  a  catarrh  constantly  visited  him 
every  summer;  and  in  another  this  was  the  only 
part  of  the  year  in  which  it  ceased  to  be  trouble- 
some. The  state  of  pregnancy  has  several  times 
been  attended  with  this  complaint :  and  I  remem- 
ber it  to  have  once  continued  for  four  years  after 
the  pregnancy.  Irregularities  of  the  menstrua, 
among  other  disorders  of  the  health,  have  also 
been  accompanied  with  an  excessive  flow  of  sali- 
va ;  and  hysteric  women  have  been  infested  with 


ilO  Commentaries  on  the 

it  for  two  or  three  months,  in  a  degree  not  infe- 
riour  to  that  of  a  moderate  sahvation  raised  with 
quicksilver.  A  bad  sore  throat  has  in  some  per- 
sons been  followed  for  a  long  time  by  a  very 
troublesome  degree  of  spitting.  But  the  salivary 
glands  are  peculiarly  affected,  as  is  well  known, 
by  mercurial  medicines ;  after  the  use  of  which  a 
considerable  salivation  has  teazed  some  patients 
for  many  months,  and  in  two  or  three  it  has  con- 
tinued frequently  to  return  for  above  three  years. 
jEthiop's  mineral  has  several  times  had  a  similar 
effect;  and  in  one  who  had  taken  it  forty  days  a 
great  spitting  ensued,  which  lasted  three  years. 
Many  women  have,  within  my  observation,  suffer- 
ed in  this  manner  from  mercurial  preparations; 
but  I  hardly  recollect  an  instance  of  it  in  the  oth- 
er sex. 

Such  extraordinary  discharges  of  saliva  have  in 
a  few  instances  evidently  wasted  the  flesh,  and 
weakened  the  body;  but  have  been  often  borne 
for  a  long  time  without  any  manifest  injury  of  the 
health.  A  weight  and  pains  of  the  head  have  so 
frequently  been  relieved  by  a  great  catarrh,  that 
in  such  cases  it  may  be  considered  rather  as  a 
remedy,  than  a  disease,  and  therefore  violent 
means  should  not  be  employed  to  check  it.  These 
pains  with  feverishness  and  a  slight  defluxion  are 
in  some  years  epidemical,  occasioning  a  remarka- 
ble languor,  at  least  for  some  days,  which  has 
hung  upon  some  patients,  together  with  night 
sweats  and  loss  of  appetite,  for  a  long  time,  and 
has  ended  at  last  in  a  fatal  pulmonary  consump- 
tion, after  a  gradual  decline  for  two  or  three 
years. 


History  and  Cure  of  Diseases,        i  11 

An  habitual  catarrh  has  spontaneously  ceased 
in  the  seventieth  year  of  hfe,  and  also  upon  the 
coming  on  of  a  palsy  ;  but  has  been  oftener  known 
to  end  in  an  asthma.  In  many  cases  a  variety  of 
means  has  been  used  to  stop  it  with  very  little  ef- 
fect. A  spontaneous  discharge  of  thin  lymph 
from  both  the  outside  and  inside  of  the  ears  has 
been  found  to  check  a  catarrh  ;  and  so  has  an 
artificial  one  made  by  a  blister.  The  pillulse  ca- 
tarrhales  of  many  dispensatories,  consisting  of 
aloes  and  opium,  seem  well  calculated  to  divert 
the  humour,  and  to  sooth  the  irritation.  The  mu- 
cilage of  quince  seeds  is  very  grateful,  where  the 
mouth  is  sore  :  where  the  glands  are  only  weak 
and  relaxed,  the  astringent  decoctions  of  oak- 
bark,  with  alum  dissolved  in  them,  may  have  their 
use.  A  fit  of  the  gout  has  supervened  a  catarrh, 
without  affording  any  relief.  Two  persons,  for 
other  purposes,  took  at  least  a  dram  of  the  Peru- 
vian bark  every  day  for  many  months,  during  all 
which  time  they  were  free  from  that  sort  of  ca- 
tarrh which  is  commonly  called  a  cold  in  the 
head,  to  which  they  had  both  of  them  been  re- 
markably subject. 


CHAPTER    25. 

Devoratio, 

A  CHILD  two  years  and  a  half  old  swallowed 
two  round  pieces  of  copper  money  :  the  diameter 
of  one  was  one  inch  and  one  tenth  of  an  inch  :  the 


11^  dommentaries  on  the 

other  was  a  little  less.  She  seemed  very  ill  lor 
the  first  week  after,  and  was  unwilling  to  take 
down  any  food ;  which  might  be  owing  to  the 
soreness  of  the  throat,  which  these  pieces  had  oc- 
casioned in  passing.  After  this  time  she  frequent- 
ly took  a  little  castor-oil,  and  enjoyed  her  usual 
health,  complaining  of  nothing.  Twenty-nine 
days  after  she  had  swallowed  these  pieces,  tliey 
were  both  voided  by  stool,  and  did  not  show  any 
sign  of  rust  or  corrosion. 

The  power  of  swallowing  is  weakened,  and 
sometimes  wholly  lost,  from  various  causes.  In 
hysteric  fits  it  is  not  uncommon  to  be  unable  to 
get  any  thing  down ;  and  a  difficulty  of  doing  it 
has  constantly  attended  some  women  every  time 
of  their  pregnancy.  It  is  often  seen  that  spasms, 
from  whatever  cause  they  arise,  will  come  on  in 
the  middle  of  eating,  stopping  for  a  little  while 
the  descent  of  any  thing  into  the  stomach,  and 
occasioning  great  efforts  to  clear  the  oesophagus, 
which  force  up  much  phlegm,  but  nothing  of 
what  had  been  before  eaten.  This  has  returned 
at  very  uncertain  periods,  once  in  ten  days,  or 
three  or  four  times  in  a  year,  and  has  lasted  in 
this  manner  for  several  years.  The  muscles  serv- 
ing  to  deglutition  are  also  liable  to  be  seized  with 
a  paralytic  weakness,  rendering  them  incapable 
of  performing  their  proper  offices.  A  still  more 
dangerous  species  of  this  disorder  arises  from  a 
strumous  swelling  of  the  glands,  which  happens 
in  all  parts  of  the  oesophagus  from  the  fauces  to 
the  cardia ;  in  consequence  of  which  the  swallow- 
ing becomes  gradually  more  and  more  difficult, 
till  it  be  at  last  totally  obstructed.     I  have  known 


History  and  Cure  of  Diseases,      113 

the  same  fatal  mischief  happen  to  the  respiration 
froni  the  same  cause. 

Besides  these  general  incapacities  of  swallow- 
ing any  thing,  there  are  partial  ones,  which  re- 
spect only  particular  things.  Some  have  been 
able  to  swallow  any  food,  except  meai ;  others 
have  readily  taken  down  liquids,  but  not  solids ; 
and,  what  is  more  strange,  in  other  cases  solids 
have  found  a  passage  down  into  the  stomach  with 
much  greater  ease  than  liquids.  Though  I  have 
had  opportunities  of  frequently  observing  most  of 
these  complaints,  yet  I  have  not  been  able  to  sa- 
tisfy myself  that  any  means  which  I  have  used 
have  proved  peculiarly  serviceable,  above  the  ge- 
neral method  of  treating  those  distempers  to 
which  the  complaints  appear  to  be  related.  The 
use  of  nourishing  clysters  is  well  known,  by  the 
assistance  of  which  time  may  be  gained  ;  and  this 
in  some  of  these  disorders  is  of  the  utmost  impor- 
tance. 


CHAPTER  26. 

Diabeies. 

The  diabetes  is  a  complaint  which  happily  oc- 
curs but  seldom  ;  and  hence,  1  imagine,  it  has  hap- 
pened, that  the  history  of  it  in  books  is  not  very 
clear  and  precise  ;  nor  has  my  own  experience 
satisfied  me  in  supplying  their  defects.  I  have 
scarcely  had  opportunities  of  observing  twenty 
cases,  where  this  was  supposed  to  be  the  distem- 
15 


114  Commentaries  on  the 

per ;  and  some  of  these  seemed  not  to  deserve 
the  name.  In  fevers,  which  proved  fatal,  1  have 
once  or  twice  known  the  symptom  of  a  perpetual 
making  of  water,  and  in  large  quantities,  with  in- 
exringuisliable  thirst.  But  the  more  usual  man- 
ner in  which  this  excess  of  urine  shows  itself, 
ranks  it  with  chronical  disorders.  An  unusual 
thirst  is  first  taken  notice  of,  with  a  tongue  rough 
and  furred,  and  a  bad  taste  in  the  mouth;  the  ap- 
petite fails;  the  pulse  is  too  quick;  the  strength 
and  flesh  waste ;  the  skin  is  in  a  burning  heat, 
without  the  least  tendency  to  sweat ;  the  thirst 
makes  these  patients  drink  immoderately,  and  of 
course  they  make  water  much  more  frequently 
than  is  common  to  them,  and  in  much  larger 
quantities,  like  hysterical  persons. 

The  urine  should  naturally  be  about  four  fifths 
of  the  drink;  but  even  in  health  it  will  fall  consi- 
derably short  of  this  now  and  then  for  the  space 
of  a  day,  and  will  sometimes  exceed  the  whole  of 
what  has  been  drunk ;  and  when  it  does,  it  will 
resemble  common  water  more  than  urine,  in  its 
want  of  colour,  taste,  and  smell.  The  urine  in  a 
diabetes  is  said  to  have  a  honey-like  sweetness ; 
but  in  my  judgment,  formed  upon  the  most  per- 
fect cases  of  this  distemper,  it  ought  in  most  per- 
sons rather  to  be  called  insipid  :  in  one,  joined 
with  a  fever,  I  found  it  sweetish.  An  extraordi- 
nary flow  of  urine  has  been  remarkable  for  some 
months ;  and  yet,  when  measured,  has  not  been 
found  to  exceed  the  drink,  which,  on  account  of 
the  thirst,  is  more  than  these  patients  are  usually 
aware  of  However,  towards  the  end  of  the  dis- 
temper, the  urine  will  considerably  surpass  the  li- 


I 


History  and  Cure  of  Diseases,       ii^ 

quor,  so  as  to  be  double  of  what  they  have  taken. 
This  deviation  of  the  urine  from  its  natural  state 
will  continue  sometimes  more,  and  sometimes 
less,  for  three  or  four  jears,  and  has  returned  af- 
ter seeming  to  be  entirely  gone. 

Though  the  excess  of  urine  is  the  circumstance 
which  has  been  chiefly  attended  to,  yet,  in  every 
case  of  this  kind  which  1  have  seen,  the  thirst  has 
been  first  in  time,  and  by  far  the  most  distressing, 
and  what  ought  rather  to  have  given  name  to  the 
distemper;  but,  in  truth,  they  seem  both  to  be 
rather  symptoms  of  the  breaking  up  of  a  consti- 
tution, and  have  hardly  ever  been  known  but  in 
very  infirm  and  old  people,  in  whom  age  or  dis- 
temper had  so  far  injured  some  of  the  parts  ne- 
cessary to  life,  that  death  must  soon  have  ensued, 
whether  the  patient  made  too  much  water,  and 
was  wasted  in  a  diabetes,  or  made  hardly  any, 
and  was  bloated  in  a  dropsy.  It  is  not  very  im- 
probable, that  some  trivial  circumstance  deter- 
mined the  body  to  take  on  one  of  these  two  dis- 
eases rather  than  the  other,  and  that  the  remov- 
ing of  either  of  them  would  do  but  little  towards 
saving  the  patient's  life. 

If  the  diabetes  be,  as  I  am  inclined  to  think, 
the  symptom  of  some  other  distemper,  and  not 
the  disease  of  any  of  the  organs  which  secrete 
the  urine,  the  only  useful  remedies  will  be  those 
which  are  directed  to  cure  the  principal  malady, 
of  which  the  diabetes  is  but  an  appendage.  Ac- 
cordingly it  has  appeared  to  me,  that  little  good 
was  to  be  done  with  alum,  the  Peruvian  bark, 
elixir  of  vitriol,  Bristol  water,  lime  water,  a  repe- 


116  Commentaries  on  the 

titioii  of  emetics,  or  any  other  medicines,  which 
were  principally  calculated  to  recover  the  kid- 
neys from  their  supposed  relaxed  state  to  their 
natural  tone  and  firmness.* 


CHAPTER  27. 

Diarrhcea, 

A  DIARRHCEA  aHses  from  a  variety  of  causes, 
most  of  which  are  void  of  all  danger,  and  are  ea- 
sily removed.  It  is  often  brought  on  by  that 
power,  which  is  exerted  in  every  part  of  the  body, 
of  freeing  itself  from  any  thing  painful  and  op- 
pressive. Not  only  the  mischief  from  the  noxious 
qualities,  and  improper  quantities  of  what  has 
been  taken,  and  immediately  offends  the  stomach, 
are  carried  off  by  means  of  a  diarrhcea,  but  like- 
wise many  disorders  of  remote  parts,  or  of  the 
whole  body,  (such  as  morbid  impressions  from 
the  causes  of  epidemical  coniplaints,  and  of  fe- 
vers) are  by  the  self-correcting  powers  of  an  ani- 
mal body  determined  to  the  bowels,  and  thence* 
discharged  by  a  diarrhoea. 

The  observation  of  this  has  given  occasion  to 
that  useful  caution  of  not  being  too  hasty  in  stop- 
ping a  recent  spontaneous  purging,  it  being  fre- 

*  A  young  man,  who  had  laboured  under  a  true  diabetes  for 
twelve  monUis,  was  seized  with  an  acute  fever,  and  died.  The 
body  wliich  was  carefully  examined,  showed  no  marks  of  disease. 
The  kidneys  weve  iujagined  to-be  rather  fuller  of  blood  than  usu- 
al ;  and  the  gall-bladder  was  perfectly  empty. — E. 


History  and  Cure  of  Diseases.      117 

quently  useful  to  co-operate  with  nature  in  pro- 
moling  this  evacuation.  For  this  purpose  rhu- 
barb has  been  chiefly  recommended,  and  deserv- 
edly; but  instead  of  rhubarb  I  have  many  times 
given  two  or  three  drams  of  the  neutral  purging 
salts,  and  think  they  have  always  done  as  well, 
and  in  some  cases  better,  by  making  a  more  speedy 
and  complete  evacuation  of  what  had  offended  the 
bowels,  and  with  less  sickness.  An  emetic  is  also 
successfully  used  where  the  nausea  is  very  great; 
but  otherwise  1  think  a  vomit  is  unnecessary. 
Fifteen  grains  of  powdered  ipecacuanha,  or  even 
half  a  pint  of  carduus  or  camomile-flower  tea,  will 
jBufliciently  answer  this  purpose.  ^ 

After  what  had  oppressed  the  bowels  has  been 
removed,  a  weak  or  two  irritable  a  state  of  them 
may  still  continue  :  hence  arise  indigestions,  flatu- 
lence, heartburn,  frequent  returns  of  the  diar- 
rhoea, and  a  predominant  acid  in  the  stomach. 
The  testaceous  powders  and  chalk  julep  are  the 
proper  correctors  of  this  too  ready  acescence  of 
the  humours;  which  therefore  should  be  employ- 
ed :  but  they  will  not  alone  be  of  much  avail  in 
stopping  a  diarrhoea  which  is  considerable  enougji 
to  require  any  medicines  at  all.  Nutmeg,  cinna- 
mon, pomegranate  bark,  and  many  other  astrin- 
gent vegetable  substances,  are  much  more  effica- 
cious, but  yet  often  require  to  be  joined  with 
remedies  which  sooth  the  too  great  irritableness 
of  the  intestines,  namely  gum-arabic,  starch,  and 
opiates.  Half  a^lram  of  testaceous  powder,  fif- 
teen grains  of  pomegranate  bark,  and  half  a  scru- 
ple of  nutmeg,  with  three  drops  of  tincture  of  opi- 
um, may  be  taken  in  any  distilled,  or  common 


118  Commentaries  on  the 

water,  once  or  twice  a  day  in  the  more  chronical 
and  habitual  purgings,  or  once  in  six  hours  iu^the 
more  recent  and  violent  ones.  Tinctura  opii  mix- 
ed in  anj  pleasant  julep,  so  as  to  let  the  patient 
take  as  much  as  contains  three  or  four  drops  after 
every  pinging  stool,  is  in  many  cases  required  : 
and  besides  this  manner  of  giving  the  opium,  it  is 
often  extremely  serviceable  to  give  from  twenty 
to  forty  drops  in  a  quarter  of  a  pint  of  mucilage 
of  quince  seeds,  or  of  starch,  administered  in  a 
clyster.  Gum-arabic  dissolved  in  water,  or  in 
milk  and  water,  may  be  taken  to  the  quantity  of 
one  ounce  in  twenty-four  hours :  and,  lastly,  one 
large  spoonful  of  clean  mutton  fat,  mixed  with  a 
quarter  of  a  pint  of  milk  hot  enough  to  melt  the 
fat,  and  drunk  twice  a  day,  is  not  only  a  good  re- 
medy, but  nourishing  food. 

This  method  has  appeared  to  me  the  most  ef- 
fectual, where  the  diarrhoea  was  curable  and  need- 
ed to  be  cured  ;  but  there  are  instances  of  its  be- 
ing habitual  and  harmless,  at  least  for  several 
years,  and  returning  upon  the  slightest  occasions 
for  the  greatest  part  of  a  person's  life.  I  have 
seen  an  instance  of  a  diarrhoea's  continuing  for 
three  months  at  the  rate  of  twenty  times  in  a  day 
without  any  apparent  injury  to  the  health.  In 
such  cases  it  is  difficult,  and  perhaps  hardly  desi- 
rable, to  effect  a  cure  of  what  is  not  so  much  a 
distemper,  as  an  inconvenience,  which  may  be 
more  than  compensated  by  the  benefit  which  it 
does  to  the  general  habit  of  me  body.  Where 
the  appetite  fails,  and  the  flesh  wastes,  no  time 
should  be  lost  in  checking  the  purging ;  but  if 
neither  of  these  be  affected,  a  cautious  delay,  and 


I 


History  and  Cure  of  Diseases.       119 

gentle  remedies,  will  prove  the  best  means  of  re- 
storing the  patient. 

Among  the  many  causes  of  diarrhoeas,  there 
are  some,  though  few  in  proportion  to  the  others, 
which  are  neither  to  be  checked  by  the  milder, 
nor  subdued  by  the  more  vigorous  methods  of 
cure,  but  end  only  in  the  patient's  death,  after 
having  been  in  vain  opposed,  as  is  usual  in  despe- 
rate cases,  by  a  variety  of  regular  and  irregular 
practitioners.  In  some  of  these  the  glands  of  the 
mesentary  and  intestines  have  been  found  schir- 
rous ;  in  others,  though  they  were  opened,  and 
all  the  parts  examined  by  the  most  experienced 
and  dexterous  anatomists,  the  stomach  and  bow- 
els have  appeared  in  a  natural  state,  and  no  cause 
of  the  distemper  could  be  discovered.  1  have 
not  mentioned  a  sea  voyage,  nor  the  Bath,  be- 
cause 1  have  known  them  fail  so  often,  that  I  have 
no  encouragement  to  depend  upon  them ;  and  ra- 
ther think,  where  they  have  been  supposed  to 
be  successful,  that  the  success  was  in  reality  ow- 
ing to  other  causes. 


CHAPTER  28. 

Digitorum  Nodi, 

Wh.\t  are  those  little  hard  knobs,  about  the 
size  of  a  small  pea,  which  are  frequently  seen  up- 
on the  fingers,  particularly  a  little  below  the  top, 
near  the  joint  ?  They  have  no  connexion  with  the 
gout,  being  found  in  persons  who  never  had  it ; 


ISO  Commentmnes  on  the 

they  continue  for  life ;  and  being  hardly  ever  at- 
tended with  pain,  or  disposed  to  become  sores, 
are  rather  unsightl}^  than  inconvenient,  though 
they  must  be  some  little  hindrance  to  the  free  use 
of  the  fingers. 


CHAPTER   29. 

Dolor, 

Pain  is  a  symptom  attending  upon  a  variety  of 
disorders,  and  is  spmetimes  itself  the  whole  dis- 
temper. It  is  distinguished  sometimes  by  being 
periodical ;  sometimes  it  has  a  particular  name 
from  the  part  which  is  frequently  its  seat ;  as 
head-ach,  hemicrania,  lumbago.  All  other  parts 
of  the  body,  which  have  any  sense  of  feeling,  are 
necessarily  liable  to  pain,  though  they  be  not  so 
frequently  molested,  as  that  the  pain  should  be 
ranked  as  a  distinct  species  with  ^  particular 
name.  Accordingly,  there  is  no  part  of  the  body, 
or  limbs,  in  which  I  have  not  observed  a  trouble- 
some and  lasting  pain  without  any  discolouring, 
or  swelling,  or  tendency  to  inflammation.  It  will 
remain  fixed  in  the  same  place  not  only  for 
months,  but  frequently  from  one  to  ten  years  ;  and 
I  have  known  such  a  pain  complained  of  for  fif- 
teen, sixteen,  seventeen,  twenty-four,  and  even 
thirty  years. 

The  more  lasting  of  these  pains  are,  as  might 
be  expected,  moderate  in  degree  :  however,  a  few 
have  continued  for  years,  and  yet  at  times  have 


t 


History  and  Cure  of  Diseases,     ISl 

raged  with  a  veheraonce  scarcely  to  be  endured. 
Both  sexes  are  subject  to  them,  but  women  much 
ot'tener  than  men,  and  particularly  the  very  young, 
and  the  iniirm,  and  the  pregnant.  The  thorax 
and  hypochondria  are  the  parts  which  most  fre- 
quently suffer  from  them  ;  and  though  some  of 
these  uneasy  sensations  gaay  arise  from  internal 
disorders,  yet  in  many  instances  there  has  been 
no  reason  to  suspect  that  the  hjngs,  or  liver,  or 
any  other  of  the  viscera,  had  the  least  share  in 
producing  them.  In  most  of  these  patients  the 
pains  could  not  be  traced  up  to  any  certain  cause  ; 
but  in  several  they  have  apparently  arisen  from 
terrour  and  grief,  and  anxiety,  and  have  unques- 
tionably been  recalled  and  exasperated  by  some 
disturbance  of  mind. 

In  several  instances  no  sort  of  relief  has  been 
obtained  from  the  cold  bath,  fomentations,  lini- 
ments with  or  without  tinctura  opii,  warm  plas- 
ters, blisters,  cupping,  vomiting,  purging,  sudori- 
fics  :  setons,  and  even  a  spontaneous  abscess  near 
the  part  affected  has  failed  of  doing  good  ;  Bath, 
and  sea  voyages,  have  proved  equally  unsuccess- 
ful. It  is  probable  that  no  great  hurt  is  done  to 
the  seat  of  this  pain,  since  it  has  continued  so  long 
without  causing  any  swelling  or  change  of  colour ; 
and  yet  I  have  once  or  twice  known  such  ill-con- 
ditioned biles,  and  such  a  tendency  to  a  mortifica- 
ion,  follow  the  use  of  a  blister,  as  if  the  part  was 
far  from  being  in  a  perfectly  sound  state  ;  though 
there  were  no  manifest  signs  of  its  being  other- 
wise, except  the  pain.  Tlie  means  which  have 
the  seldomest  failed,  and  have  in  some  cases  evi- 
dently contributed  to  the  cure,  are  cold-bathing, 
16 


1S2  Commentaries  on  the 

small  perpetual  blisters,  or  (if  there  be  objections 
to  blisters)  emplastrum  cymini  worn  for  a  long 
time.  The  most  powerful  internal  medicine  is 
tinctura  opii,  from  ten  drops  to  thirty  given  at 
night  alone,  or  as  many  choose  to  give  it,  either 
in  a  spoonful  of  lac  ammoniacura,  or  with  a  quar- 
ter of  ^  grain  of  emetip  tartar.  The  extract  of 
hemlock  has  now  and  then  appeared  to  weaken 
the  cause  of  these  obstinate  ails.  Cupping  has 
sometimes  succeeded  ;  hut  all  other  bleeding,  to- 
gether with  emetics,  and  cathartics,  have  general- 
ly proved  at  least  useless. 

Beside  the  pains  which  are  either  constantly 
felt,  or  rage  at  certain  times,  there  are  others 
which  are  regularly  intermittent,  the  fits  of  which 
return  as  periodically  as  those  of  an  ague  :  such  I 
have  known  in  the  bowels,  stomach,  breast,  loins, 
arms,  and  hips,  though  it  be  but  seldom  that  these 
parts  suffer  in  this  manner ;  but  the  head  and  face 
are  frequently  afflicted  with  a  periodical  pain, 
which  by  its  violence  and  duration  is  not  the  least 
of  the  maladies  which  embitter  human  hfe ;  of 
these  some  account  will  be  found  under  the  arti- 
cle Capitis  Dolores  inter mittentes. 


CHAPTER  30. 

Dolores  vagi. 

Wandering  pains  are  near  akin  to  the  rheuma- 
tism, but  may  be  distinguished  from  it  by  their 
being  accompanied  neither  with  swelling,  nor  any 


Mstovy  and  Cure  of  Diseases.       183 

discolouring  of  the  skin.  Are  they  not  chiefly 
suflfered  by  those,  whose  muscular  fibres  Rave 
been  weakened,  strained,  or  stiffened,  by  long  ill- 
nesses, profuse  bleedings,  bruises,  irregular  living, 
hard  working,  or  the  advances  of  age  ?  They  usu- 
ally continue  for  many  years  witFiout  other  ill  con- 
sequences than  becoming  gradually  a  little  more 
troublesome ;  but,  in  a  very  few,  the  parts  princi- 
pally affected  have  their  power  of  motion  more 
and  more  lessened,  till  at  last  it  be  quite  lost. 
Time,  and  Warm  bathing,  and  flannel,  may  contri- 
bute a  little  to  the  cure,  or  relief,  or  however  to 
checking  the  progress  of  these  Ails  ;  and  there  are 
scarcely  any  other  helps  to  be  given. 


CHAPTER    31. 

Dysenteria, 

The  Dysentery  is  common  in  camps,  but  does 
not  often  infest  those  who  live  in  healthy  places 
with  the  conveniences  of  life  about  them,  except 
at  certain  seasons,  when  it  becomes  epidemical,, 
particularly  among  children,  old  women,  and  in- 
firm men,  and  it  is  then  fatal  to  many.  The  dis- 
tinguishing symptoms  of  it  are  frequent  wants  of 
going  to  stool,  with  excessive  pain,  and  the  void- 
ing without  any  relief  a  very  little  inodorous  mu- 
cus, often  tinged  with  blood,  and  sometimes  pure 
blood  ;  a  pain  just  under  the  navel,  together  with 
a  fever,  and  great  loss  of  appetite,  sleep,  and 
strength,  and  sometimes  a  vomiting. 


134  Commentaries  on  the 

Since  this  distemper  is  commonly  bred  in  camps 
by  foul  air,  and  is  in  some  degree  contagious  (yet 
I  have  seldom  seen  two  dysenteric  persons  in  the 
same  house,)  too  great  care  cannot  be  taken  in 
regard  to  cleanliness  and  fresh  air,  both  for  the 
sake  of  the  patient  and  his  attendants.  The  usu- 
al methods  of  treating  this  malady  with  which  I 
was  acquainted,  eften  failed  of  procuring  ease, 
and  of  preventing  its  ending  fatally  in  a  sphace- 
lus of  the  bowels.  It  appeared  that  in  a  dysente- 
ry some  hurtful  humours  had  been  deposited  in 
the  intestines,  which  threw  them  into  such  disor- 
derly a<>Mtations  as  to  hinder  the  expulsion  of 
what  had  offended  them.  The  readiness  with 
which  the  neutral  salts  (especia|ly  the  cathartic 
salt)  purge,  their  power  of  controlling  and  quiet- 
ing the  irregular  motions  of  the  bowels,  and  their 
aptness  to  stay  upon  the  stomach  without  being 
vomited  up,  made  me  conceive  hopes  that  they 
Would  make  a  valuable  addition  to  the  anti-dysen- 
teric medicines.  At  first  I  gave  only  one  dram 
every  six  hours,  which  evidently  soothed  the  pains 
very  soon,  and  before  it  had  any  effect  as  a  purge. 
In  other  cases  larger  quantities  were  given,  and 
with  the  double  good  effect  both  of  affording  pre- 
sent ease,  and  afterwards  of  entirely  removing, 
by  effectual  evacuations,  the  cause  of  the  disor- 
der. 

After  the  danger  of  the  distemper  is  past,  the 

f)atient  will  still  be  teazed  with  a  tenesmus  as 
ong  as  any  soreness  or  extraordinary  tenderness 
of  the  rectum  remains  ;  in  which  case  a  clyster  of 
half  a  pint  of  fat  mutton  broth  and  twenty  drops 
oi  tinctura  Thebaica  scarcely  ever  fails  of  prov- 


History  and  Cure  of  Diseases,        125 

in^  a  cure ;  and  it  is  almost  the  onlj  stage  of  the 
illness  in  which  opium  is  either  useful  or  safe  :  if 
it  were  given  in  the  beginning  to  quiet  the  pain 
before  any  evacuation  had  been  made,  1  appre- 
hend it  would  be  very  prejudicial. 

Where  this  distemper  has  ended  fatally,  it  has 
been  attended  with  a  hiccup,  and  a  fetid  water 
voided  by  stool. 


CHAPTER  32. 

Ebrietas, 

The  effects  of  hard  drinking  are,  flatulence, 
loss  of  appetite,  morning  sickness,  wasting  of  the 
flesh  and  strength,  tremblings,  pains  of  the  sto- 
mach, cough,  jaundice,  dropsy,  forgetfulness  and 
inattention,  giddiness,  diarrhoea,  broken  sleep. 

If  remedies  be  applied  in  time,  and  the  habit  of 
drinking  can  be  broken,  much  may  be  hoped  for 
in  restoring  the  health.  It  is  generally  a  favoura- 
ble circumstance  to  have  an  illness  arise  from  an 
external  cause,  rather  than  from  any  internal  fail- 
ing. Men  of  a  strong  constitution  and  high  health 
are  those  who  most  usually  indulge  themselves  in 
this  excess;  and  these  circumstances,  which  be- 
trayed them  into  their  danger,  will  greatly  assist 
in  helping  them  out. 

Bath  water  seems  specifically  efficacious  in  cur- 
ing these  complaints,  if  applied  to  in  time,  before 
the  liver  and  stomach  are  too  deeply  hurt.     Nor 


1S6  Commentaries  on  the 

is  Bath  only  a  remedy  against  the  mischief  which 
has  been  already  done ;  but  it  is  also  singularly 
useful  in  preventing  a  relapse,  by  enabling  the 
patients  to  correct  the  habit  of  drinking :  for  the 
nature  of  this  water  is  so  friendly  in  warming  and 
comforting  the  stomach,  as  to  relieve  all  that 
coldness  and  anxiety  which  almost  irresistibly 
force  a  hard  drinker  to  fly  to  strong  liquors  for 
ease  under  these  insufferable  sensations.  Warm 
aperient  medicines  occasionally  used  so  as  to  pre- 
vent costiveness,  if  there  be  a  disposition  that  way, 
and  bitters,  are  the  whole  of  what  is  further  ne- 
CGssarv  to  establish  the  health. 


CHAPTER  33. 

Epilepsia, 

The  epilepsy  may  be  called  the  reproach  of 
physicians  as  well  as  the  gout ;  for  it  was  well 
known  before  the  writing  of  the  most  ancient  me-r 
dical  books,  and  yet  no  certain  method  of  cure 
has  been  discovered.  The  number  of  remedies, 
which  are  to  be  found  for  it  in  books  and  vulgar 
tradition,  afford  a  strong  presumption  that  we 
have  no  effectual  one.  The  difficulty  of  curing 
this  disease,  either  by  the  cautious  practice  of 
such  who  have  a  character  to  lose,  or  the  more 
hazardous  attempts  of  men  who  have  a  character 
to  get,  is  sufficiently  evident  from  its  having  re- 
mained uncured  in  some  who  were  enabled  by 
their  wealth  and  power^  and  proiopted  by  their 


History  and  Cure  of  Diseases. 

credulity,  impatience,  or  despair,  to  try  all  sorts 
of  means  for  its  removal.  The  good  sense  of  the 
world  has  done  more  than  medicine  towards  miti- 
gating this  great  evil,  by  lessening  the  imaginary 
part  of  it :  for  it  is  now  generally  considered  in 
the  same  light  with  any  other  distemper,  without 
adding  to  its  malignity  by  the  workings  of  fancy 
or  superstition.  It  is  no  longer  believed  to  be 
the  immediate  effect  of  some  demon's  malice ;  nor 
is  it  regarded  enough  to  let  it  dissolve  public 
councils,  and  to  put  a  stop  to  all  business;  neither  is 
it  detested  with  that  degree  of  horrour  by  the  ac- 
quaintance and  friends,  which  must  have  shocked 
the  miserable  patient  more  than  the  cruellest  at- 
tacks of  the  disease.* 

The  fit  makes  the  patient  fall  down  senseless  ; 
and  without  his  will  or  consciousness  presently 
every  muscle  is  put  in  action,  as  if  all  the  powers 
of  the  body  were  exerted  to  free  itself  from  some 
great  violence.  In  these  strong  and  universal 
convulsions,  the  urine,  excrements,  and  seed,  are 
sometimes  forced  away,  and  the  mouth  is  covered 
with  foam,  which  will  be  bloody,  when  the  tongue 
has  been  bitten,  as  it  often  is  in  the  agony.     This 

*  Among  the  ancients,  when  any  one  happened  to  be  seized  with 
an  epileptic  fit,  those  who  were  present  used  to  spit,  and  some- 
times into  their  own  bosoms;  either  to  show  their  abomination, 
or  to  avert  the  omen  from  themselves.  Piautus  calls  this  distem- 
per. Morbus  qui  spuiatur.  Captiv.  act.  iii.  seen.  iv.  v.  1&.  and 
from  what  follows,  it  seems  as  if  they  used  to  spit  upon  the  epi- 
leptics as  a  charm  to  relieve  the  convulsions.  Eum  morbum  mihi 
cwfi,  ut  qui  me  opus  sit  iiisputarier.  yer.2l.  Multos  iste  morbus 
macerate  quibus  insputari  salutifuit.  v.  22.  Hence  it  has  been  con- 
jectured, that  St.  Paul's  thorn  in  thejlesh,  2  Cor.  xii.  7.  and  infir- 
mity of  the  flesh,  Gal.  iv.  13.  and  temptation  in  the  fleshy  ver.  14. 
might  be  the  epilepsy,  and  that  the  word  «|e7r7y!raT8  isusedHterallj% 
and  not  in  a  metaphorical  sense. 


138  Commentaries  on  the 

wretched  condition  affords  a  picture  of  the  great- 
est misery  and  distress  even  to  a  stranger ;  to  the 
friends  and  relations  the  horrour  of  such  a  sight 
is  much  greater;  but  happily  the  patients  them- 
selves know  nothing  during  the  fit  of  what  the 
body  is  enduring. 

Many  suffer  these  attacks  without  the  least 
previous  notice  ;  others  are  sensible  of  their  ap- 
proach; and  the  shock  which  this  foreboding  oc- 
casions is  compensated  by  their  being  able  to 
secure  themselves  from  some  of  the  mischiefs  of  a 
sudden  unforeseen  fall.  It  is  not  unusual  to  have 
a  little  warning  of  some  of  the  first  fits,  and  after- 
wards to  have  them  come  on  without  any  previ- 
ous sign.  The  more  common  symptoms  which 
are  the  remoter  forerunners  of  a  fit,  are  a  general 
restlessness  and  uneasiness,  a  head  ach,  vertigo, 
and  other  disagreeable  feels  in  the  head,  disorders 
of  the  stomach,  and  sleepiness  ;  these  will  in  many 
persons  hang  upon  them  for  two  or  three  days 
before  they  fall.  The  most  usual  sensations  im- 
mediately before  the  fit  are  a  slight  delirium, 
which  will  sometimes  continue  three  or  four  hours, 
and  a  vapour  rising  up  out  of  the  stomach  to  the 
head,  which  in  some  few  affects  their  palates  and 
nostrils  like  musk.  The  less  common  warnings 
of  the  approach  of  the  falling  sickness  are  pains 
in  the  bowels,  numbness  of  the  hands  and  arms,  a 
peculiar  sensation  in  some  of  the  extremities  gra- 
dually diffusing  itself  all  over  the  body,  dimness 
of  sight,  a  faltering,  and  difficulty,  or  a  total  loss 
of  speech,  a  hiccup,  a  vomiting  and  purging,  a 
pain  in  the  back,  a  coldness  of  the  extremities,  a 
great  defluxioii  of  phlegm,  a  blackness  of  the  face, 


History  and  Cure  of  Diseases.      129 

and  shortness  of  breath  ;  lastly,  a  tendency  to 
fainting  will  sometimes  be  followed  by  a  fit,  and 
sometimes  the  fit  will  seem  to  rise  no  higher  than 
this,  and  the  patient  will  escape  for  that  time  with 
feeling  no  more  of  it  than  this  half  fainting,  joined 
perhaps  with  a  forgetfulness  or  delirium  for  a  few 
minutes.  These  are  the  shortest  fits  of  all ;  the 
more  common  ones  will  last  from  a  quarter  of  an 
hour  to  three  hours  ;  and  in  more  eitraordinary 
cases  the  patient  will  lie  senseless  for  two  or 
three  days,  having  during  all  this  time  frequent 
accesses  of  convulsions  or  fits.  Giddiness,  and 
dark  spots  dancing  before  the  eyes,  are  the  con- 
stant attendants  on  some  epilepsies. 

All  possible  varieties  are  to  be  found  in  the  re- 
turns of  this  distemper  :  many  will  have  several 
of  the  slighter  fits  every  day,  or  one  in  a  day,  or 
one  in  a  week,  or  every  month,  or  only  two  or 
three  in  a  year.  The  epilepsy  has  Iain  dormant 
for  thirteen  years,  and  then  returned  worse  and 
oftener ;  in  others  the  respite  has  been  still  much 
longer,  though  with  such  threatenings  of  a  re- 
lapse, as  to  put  it  out  of  all  doubt  that  the  cause 
still  remained.  After  the  convulsions  have  ceas- 
ed, and  the  patient  begins  to  come  to  himself,  he 
generally  falls  into  a  sound  sleep,  for  one,  or  two, 
or  even  six  hours.  It  is  obvious  to  suppose  that 
this  sleep  must  prove  a  relief  after  the  fatigue  of 
the  convulsions ;  and  I  never  knew  but  one  in- 
stance in  which  it  was  found  so  detrimental,  that 
the  patient  requested  always  to  be  roused  from  it, 
as  he  could  never  indulge  it  without  being  the 
worse.  It  must  be  owned  that  sleep  seems  to  fa- 
vour the  returns  of  these  fits,  just  as  it  aggravates 
17 


130  Commentaries  on  the 

all  the  distempers  attributed  to  the  nerves ;  the 
first  attacks  of  the  epilepsy  being  most  usually  in 
the  night,  just  after  the  first  sleep. 

Some  epileptics  feel  themselves  so  little  hurt  oi 
altered  by  a  fit,  that,  knowing  nothing  of  what 
passes  during  the  time  of  it,  they  can  hardly  be 
persuaded  that  they  have  had  one.  Others  af- 
ter they  have  come  to  themselves  have  felt  a  hea- 
viness and  numbness  for  three  hours,  or  a  head- 
ach,  a  sickness  and  vomiting,  a  languor  and  dull- 
ness, or  have  not  perfectly  recovered  their  under- 
standing and  memory  for  two  or  three  days :  and 
these  are  the  immediate  effects  of  single  fits> 
The  more  distant  ones  of  repeated  fits  are,  forget- 
fulness,  stupidity,  childishness,  and  a  general  de- 
bility of  the  body,  or  a  palsy  of  some  parts,  or  an 
apoplexy.  These  consequences  appear  very  soon 
in  some,  while  others  continue  a  long  time  unhurt 
by  these  violent  shocks  ;  so  that  some  who  began 
to  labour  under  this  malady  very  early  in  life,  and 
had  experienced  many  returns  of  it,  have  yet  liv- 
ed to  be  promoted  to  some  high  offices  in  the 
state,  merely  on  account  of  their  extraordinary 
abilities.  Julius  Caesar  is  well  known  to  have 
been  a  remarkable  instance  of  this  kind. 

Both  sexes,  and  every  age,  are  liable  to  this  ill- 
ness ;  children  are  much  more  so  than  adults,  and 
much  more  easily  get  rid  of  it.  One  would  like- 
wise expect  that  the  weaker  sex  would,  on  ac- 
count of  their  weakness,  be  greater  sufferers  by 
epilepsies  ;  but  it  has  appeared  to  me,  that  though 
boys  and  girls  be  equally  subject  to  epileptic  con- 
vulsions, yet  fewer  women  are  afflicted  with  them 


History  and  Cure  of  Diseases,       lai 

than  men.  Convulsions  are  so  common  in  chil- 
dren, from  the  day  of  their  birth  to  their  third  or 
fourth  year,  as  to  make  it  probable  that  they  may 
be  occasioned  by  a  variety  of  transient  causes, 
such  as  worms,  accidental  indigestions,  griping 
pains  of  the  bowels,  and  many  other  sharp  and 
sudden  pains ;  there  is  therefore  always  ground 
to  hope  that  a  child's  convulsions  may  not  pro- 
ceed from  the  same  obstinate  cause  from  which 
epilepsies  arise  in  adults ;  and  accordingly  many 
children  under  four  or  five  years  of  age  have  had 
a  few  such  fits,  who  have  never  afterwards  expe- 
rienced a  return.  The  true  epilepsy  most  usual- 
ly shews  itself  in  childhood  or  youth ;  but  there 
is  hardly  any  time  of  life,  from  the  first  day  of  it 
to  extreme  old  age,  at  which  it  has  not  been 
known  to  make  its  first-  appearance.  I  have  not- 
ed several  who  have  begun  to  be  epileptic  at  al- 
most every  year  between  twenty  and  Mty  ;  a  few 
have  fallen  into  it  at  sixty  ;  and  I  saw  one  whosd 
first  attack  was  in  the  seventy-fifth  year  of  his  life, 
and  from  that  time  he  was  often  visited  with  it  for 
at  least  six  or  sev^n  years,  and  probably  as  long 
as  he  lived. 

It  has  been  an  old  observation  among  physi- 
cians,  that  epilepsies  beginning  in  childhood  often 
terminate  about  the  year  of  puberty ;  which  has 
by  no  means  been  Verified  by  any  experience 
which  has  fallen  in  my  way.  On  the  contrary, 
this  malady  has  appeared  to  me  often  to  come  on 
at  that  time  o(  life,  but  1  have  not  remarked  one 
instance  of  its  yielding  in  either  sex  to  the  change 
made  by  puberty.  Wherever  it  has  lasted  be- 
yond the  fifth  or  sixth  year,  it  has  generally  prov- 


13S  Commentaries  on  the 

ed  a  tedious  distemper,  and  reached  it  beyond  the 
beginning  of  maturity.  If  I  could  therefore  sup- 
pose that  in  forty  years  practice  a  sufficient  num- 
ber of  epilepsies  might  occur  upon  which  to  form 
a  judgment  of  this  aphorism,  I  should  be  inclined 
to  think  that  it  was  founded  on  theory,  or  in  the 
hopes  of  the  physician,  rather  than  in  fact.  As 
there  is  no  age  at  which  this  great  affliction  does 
not  come  on,  so  there  is  hardly  any  at  which  it 
has  not  finally  left  the  patient.*  But  it  must  be 
owned  that  it  is  doubtful  whether  nature  has  not 
had  more  share  in  most  cures  than  medicine,  be- 
cause there  is  none  which  has  not  failed  so  often, 
that  we  cannot  be  confident  of  its  having  much 
merit  where  it  has  appeared  to  succeed. 

The  epilepsy  is  in  some  degree  hereditary;  yet 
as  there  are  several  examples  of  its  being  cured, 
or  spontaneously  ceasing,  in  those  whom  it  had 
frequently  attacked,  there  is  a  stronger  reason  to 
hope  that  its  powers  may  be  often  spent  before  it 
reaches  the  children ;  and  it  is  found  in  fact,  that 
many  pass  their  whole  lives  untainted  with  this 
part  of  the  constitution  of  their  parents. 

In  the  beginning  of  the  epileptic  fit  care  should 
be  taken  to  loosen  any  bandage  which  might  be 
about  the  neck ;  for  this  part  is  apt  to  swell,  and 
without  this  precaution  might  endanger  suffoca- 

*  Nicolaus  Leonicenus  a  cunabulis  ipsis  ad  trigesimum  annum 
morbo  comitiali  adeo  laborabat,  ut  pertaesus  vitae  pene  sibi  ma- 
nus  afferret :  sed  post  trigesimum  annum  plane  eo  malo  defunc- 
tus,  omnibus  membrorum  ac  sensuum  officiis  integer,  nnlla  morbi 
suspieione  ad  quartum  et  Donagesimum  annum  perFcnit. — Jos 
Seal,  ep.  19. 


History  and  Cure  of  Diseases.      133 

tion  :  the  patient  should  be  placed  upon  a  couch, 
or  bed,  and  watched  that  he  may  not  fall  off,  and 
that  he  may  not  throw  his  legs  or  arms  about  in 
such  a  manner  as  to  hurt  himself.  All  further 
officiousness  will  be  prejudicial.  To  force  liquids 
into  the  mouth,  to  hold  pungent  salts  to  the  nose, 
to  rub  the  temples,  and  to  force  open  the  hands, 
is  certainly  useless,  and  not  quite  innocent.  To 
open  a  vein  upon  account  of  the  fit  is  still  worse, 
being  a  needless  waste  of  blood,  which  may  weak- 
en the  patient,  but  not  the  disease.  The  interval 
of  the  fits  is  the  only  proper  time  in  which  any  re- 
medies should  be  employed ;  and  in  such  cases  as 
this,  where  the  experience  of  mankind  has  not  yet 
discovered  any  upon  which  we  can  have  much  de- 
pendence, there  is  the  most  good  to  be  done  by 
finding  out  the  weak  part  of  the  patient's  consti- 
tution, and  directing  such  means  as  will  keep  him 
in  the  best  general  health,  that  he  may  have  eve- 
ry assistance  from  the  powers  of  life  ;  for  they  are 
so  formed,  that  they  are  always  ready  to  exert 
themselves  in  weakening  and  removing  whatever 
distresses  them ;  and  the  stronger  they  are,  the 
more  vigorous  and  successful  will  their  efforts  be. 

No  simple  has  had  a  greater  reputation  as  an 
ante-epileptic  than  the  wild  valerian  root,  and  it 
may  have  been  beneficial  in  some  cases  ;  but  one 
ounce,  and  even  fifteen  drams,  have  been  given 
every  day  with  little  or  no  advantage.  The  gout 
has  come  on  without  affording  any  relief,  nor  can 
I  say  much  in  favour  of  blisters,  issues,  setons,  the 
cold  bath,  and  chalybeate  waters,  except  where 
they  have  been  useful  to  the  general  health. 
Quicksilver  I  have  known  used  both  inwardly  and 


d34  Commentaries  on  the 

outwardly ;  and  if  it  have  seemed  to  do  good  in 
one  case,  it  has  certainly  been  useless  in  another. 
Two  persons  have  imputed  their  cure  to  a  total 
abstinence  from  all  animal  food  ;  but  the  same  ab- 
stemious diet  has  failed  in  a  third.  Five  ounces 
of  a  very  strong  infusion  of  wild  valerian  root, 
with  one  dram  of  musk,  given  as  a  clyster  every 
eight  hours  for  three  days  in  a  desperate  case, 
had  the  credit,  and  perhaps  justly,  of  saving  the 
life  of  one  who  had  lain  senseless,  with  frequent 
returns  of  convulsions,  for  two  or  three  days. 
Worms  in  children,  or  disordered  bowels,  have 
occasioned  convulsive  fits  ;  and  gentle  purgatives 
will  generally  cure  them,  by  removing  the  cause  : 
but  purges  should  always  be  avoided  in  a  just 
epilepsy,  because  the  causes  of  it  will  be  aggra- 
vated by  purging.  I  knew  a  girl  whose  fits  al- 
ways came  on  just  after  her  having  a  stool.  Vo- 
mits 1  have  known  to  be  equally  hurtful,  and  like- 
wise bleeding.  Sleep  unquestionably  disposes  a 
fit  to  come  on,  and  a  too  great  indulgence  in  this 
article  may  probably  contribute  to  fix  the  distem- 
per. All  occasions  of  terrour  should  carefully  be 
avoided ;  for  terrour  will  not  only  bring  on  a  fit, 
but  has  been  the  original  cause  of  the  distemper. 
A  life  of  debauchery,  and  particularly  an  intem- 
perate use  of  women,  has  a  peculiar  tendency  to 
produce  and  strengthen  this  evil.  My  experience 
has  furnished  me  with  so  little  to  say  concerning 
the  numerous  anti-epileptic  medicines  to  be  found 
in  all  the  practical  writers,  that  I  must  let  their 
merit  rest  on  the  characters  of  them  which  arc 
there  to  be  found. 


History  and  Cure  of  Diseases.       135 

CHAPTER  34. 

Erysipelas. 

St.  Antony's  fire  shews  itself  in  a  redness  ot' 
the  part,  with  some  degree  of  swelhng,  heat,  and 
pain ;  and  it  is  frequently  beset  with  small  watery 
blisters.  It  very  rarely  appears  without  a  fever, 
the  usual  signs  of  which  precede  the  appearance 
upon  the  skin  for  one,  two,  or  three  days. — 
The  genuine  erysipelas  is  oftenest  seen  in  the 
face,  head,  neck,  and  shoulders  ;  yet  many  inflam- 
tions  which  are  the  forerunners  of  a  suppuration, 
or  sphacelus,  in  other  parts,  particularly  the  legs, 
have  an  erysipelatous  appearance,  and  are  called 
by  that  name. 

This  disorder  begins  with  a  small  red  spot  in 
one  of  the  parts  just  mentioned,  which  gradually 
extends  itself,  and  keeps  moving  from  one  part  to 
another.  The  skin  is  sometimes  so  deeply  hurt, 
as  to  have  an  ill-conditioned  ulcer  formed,  which 
cannot  be  healed  without  much  time  and  care. 
The  little  vesicles,  if  they  be  numerous,  will,  upon 
breaking,  make  the  part  so  sore  as  to  require 
some  soft  liniment  spread  upon  linen,  to  defend  it 
from  the  rubbing  of  the  clotnes.  Except  in  these 
two  cases,  it  is  better  not  to  make  use  of  external 
application  to  the  parts  affected.  The  height  of 
the  fever,  which  is  almost  always  joined  with  this 
disorder,  is  much  greater  than  might  be  expected 
from  the  quantity  and  degree  of  inflammation,  and 
not  seldom  rises  to  light-headedness,  and  some- 
times is  fatal ;  where  this  happens,  the  erysipela- 


136  Commentaries  on  the 

tous  part  becomes  pale,  and  the  distemper  is  said 
to  be  struck  in.  Some  constitutions  seem  par- 
ticularly subject  to  this  illness,  and  have  frequent 
returns  of  it ;  and  whoever  has  once  suffered  it, 
seems  much  more  liable  to  have  it  again.  It  has 
visited  a  person  regularly  once  every  year,  and 
sometimes  twice,  for  many  years.  The  apparent- 
ly healthy,  and  young,  are  not  entirely  secure  from 
it ;  but  it  is  much  more  common  in  those  who  are 
past  the  prime  of  life,  and  who  have  begun  to  find 
their  health  a  little  impaired.  Instead  of  giving 
vent  to  any  thing  which  injured  the  constitution, 
and  carrying  it  off,  St.  Antony's  fire  has  appeared 
to  me  at  least  to  do  no  good,  and  I  am  inclined 
to  think  it  does  some  harm. 

This  distemper  seems  to  partake  of  the  nature 
of  those  which  are  called  malignant,  more  than  of 
the  inflammatory ;  by  which  I  mean,  that  in  gene- 
ral it  does  not  require,  nor  bear,  much  evacuation. 
I  have  seen  very  dangerous  symptoms  follow  not 
only  bleeding,  but  even  a  gentle  purge,  though 
given  after  the  patient  had  begun  to  recover. 
Notwithstanding  this,  the  inflammation  may  some- 
times run  so  high,  that  it  may  be  proper  to  take 
away  a  little  blood,  which  has  been  done  with 
success;  and  I  have  found  a  spontaneous  bleeding 
at  the  nose  to  be  advantageous.  In  this,  as  in  alt 
other  feversr  it  is  necessary  to  check  whatever 
troublesome  symptoms  may  arise,  by  their  proper 
remedies ;  and  besides  these,  I  have  only  to  re- 
comme«d  two  ounces  of  a  decoction  of  bark,  with 
thirty  drops  of  tinctura  opii  camphorata,  or  two 
drops  of  tinctura  opii,  given  every  six  or  eight 
hours. 


History  and  Cure  of  I)isea8e8.     137 

CHAPTER   35. 

Essera,  or  I^ettle-Rash, 

The  nettle-rash  is  a  distemper  of  the  skin, 
which  being  attended  with  no  danger,  is  mention- 
ed but  seldom,  and  slightly  in  books ;  though  it 
be  often  so  extremely  troublesome,  that  physicians 
might  justly  have  thought  it  important  enough  to 
have  told  us  more  of  what  they  had  learned  from 
their  experience  relative  to  its  cure. 

It  has  its  English  name  from  resembling  in 
its  appearance  the  effect  of  stinging-nettles 
upon  the  skin.  Sydenham,  in  his  chapter  on  the 
erysipelas,  reckons  it  a  species  of  that  disease ; 
and  Sennertus  and  others,  describe  it  under  the 
name  of  Essera^  supposing  it  to  be  the  same  dis- 
temper with  that  which  is  so  called  by  the  Arabi- 
an physicians. 

The  little  elevations  upon  the  skin  in  the  nettle- 
rash  often  appear  instantaneously,  especially  if 
the  skin  be  rubbed,  or  scratched,  and  seldom  stay 
many  hours  in  the  same  place,  and  sometimes  not 
many  minutes.  There  is  no  part  of  the  body  ex- 
empt from  them.  Where  many  of  them  rise  to- 
gether, and  continue  an  hour  or  two,  there  the 
parts  affected  are  often  considerably  swelled ; 
which  particularly  happens  in  the  face,  arms,  and 
hands.  These  eruptions  will  continue  to  infest 
the  skin,  sometimes  in  one  place,  and  sometimes 
in  another,  for  one  or  two  hours  at  a  time,  two 
or  three  ti^nes  ^yery  day,  or  perhaps  for  the  great- 


138  Commentaries  on  the 

est  part  of  the  twenty-four  hours.  In  some  per- 
sons they  last  only  a  few  days  ;  in  others  many 
months.  I  have  known  several  complain  of  them 
for  two  years  with  very  short  intervals,  and  for 
seven,  or  even  ten  years. 

Males  and  females  are  equally  liable  to  the  es- 
sera,  and  I  have  observed  it  in  all  ages,  from 
childhood  to  decrepit  old  age.  Constitutions  taint- 
ed with  strumous,  or  harrassed  with  rheumatic 
and  hysteric  complaints,  or  broken  down  with  in- 
temperance, palsies,  and  age,  have  all  been,  as 
far  as  1  could  judge,  equally  fitted  for  this  disor- 
der ;  but  not  more  so  than  the  soundest  state  of 
health,  in  the  vigour  of  life,  to  which  all  other 
complaints  were  unknown. 

U  some  of  the  sufferers  by  this  eruption  have 
found  themselves  well  whilst  it  appeared,  and  in- 
fested with  pains  of  the  head  and  stomach,  and 
languors,  upon  its  disappearing,  others  have  com- 
plained of  as  much  languor,  and  equal  pains  of 
the  stomach,  during  the  time  of  its  appearance ; 
but  far  the  greatest  number  experience  no  other 
evil  from  it  besides  the  intolerable  anguish  arising 
from  the  itching,  which  will  sometiuies  make  them 
fall  away,  by  breaking  their  rest,  and  is  often  so 
tormenting  as  to  make  them  almost  weary  of  their 
lives. 

The  external  use  of  cantharides  has  been 
known  to  occasion  this  ail  in  several  persons,  and 
in  some  the  internal  use  of  the  wild  valerian  root; 
but  all  who  are  affected  with  it  find  the  itching 
and  Uttle  eminencies  hardly  ever  fail  to  be  brought 
on  by  any  degree  of  of  scratching  or  rubbing  the 


History  and  Cure  of  Diseases,        139 

skin.  The  seasons  of  the  year  have  no  constant 
effect  either  in  alleviating  or  exasperating  the  dis- 
order ;  and  the  same  may  be  said  of  cold  and  lieat^ 
and  particularly  of  the  heat  of  a  bed,  which  ap- 
pears to  make  some  much  better,  and  others  much 
worse.  Sea-bathing  has  seemed  to  occasion  it  in 
some,  and  to  relieve  it  in  others,  but  is  perhaps 
in  reality  innocent  and  useless  in  all,  as  it  certain- 
ly has  been  in  several,  as  well  as  warm  bathing, 
though  continued  for  an  unusual  length  of  time. 
Mercurial  and  sulphureous  ointments  have  been 
found  ineffectual  in  curing  it;  and  the  powder, 
infusions,  and  decoctions  of  white  hellebore  root, 
in  ointments  and  lotions,  have  only  for  a  short 
time  changed  the  itching  into  smarting.  Oil, 
vinegar,  and  spirit  of  wine,  applied  to  the  skin, 
will  sometimes  mitigate  the  itching,  and  afford  a 
little  present  relief. 

The  appearance  of  this  eruption  was  before 
said  to  resemble  the  sting  of  a  nettle ;  but,  to- 
gether with  such  little  risings  in  the  skin,  there 
are  sometimes  long  wheals  as  if  the  part  had  been 
struck  with  a  whip.  Whatever  be  the  shape  of 
these  eminences,  they  always  appear  solid,  with- 
out having  any  cavity  or  head  containing  either 
water  or  any  other  liquor  ;  and  this  affords  a  use- 
ful mark  by  which  this  cutaneous  affection  is  dis- 
tinguishable from  the  itch;  for  it  often  happens 
that  the  insufferable  itching  attending  this  erup- 
tion provokes  the  patient  to  scratch  the  parts  so 
violently,  as  to  rub  off  a  small  part  of  the  cuticle 
on  the  top  of  these  little  tumours  ;  a  little  scab 
succeeds,  and  when  the  swelling  has  gone  down. 

I  there  is  left  an  appearance  hardly  to  be  distin- 
1 


140  Commentaries  on  the 

guished  from  the  itch,  but  by  the  circumstance 
just  now  mentioned.  It  has  been  this  exact  re- 
semblance which  has  occasioned  the  appHcation 
of  sulphureous  and  mercurial  ointments  in  many 
persons  whom  I  have  seen,  without  producing 
either  any  good  or  bad  effect.  The  essera  fur- 
ther differs  from  the  itch  in  not  being  infectious ; 
for  though  I  have  once  suspected  that  a  husband 
had  catched  it  from  his  wife,  yet  my  suspicion  was 
probably  not  well  founded  in  this  instance,  be- 
cause in  many  others  I  have  known  that  this  com- 
plaint shewed  no  signs  of  being  communicable  by 
contagion. 

I  never  saw  a  reason  to  suppose  it  had  occa- 
sioned any  such  viciousness  of  the  humours,  as 
greatly  to  require,  or  to  be  much  the  better  for 
internal  alterative  remedies  :  and  if  the  itching 
could  be  certainly  and  expeditiously  allayed,  we 
might  spare  ourselves  the  pains  of  looking  out  for 
any  other  method  of  cure. 


CHAPTER  36. 

Expergefacti  cum  Clamore  et  Terrore. 

To  wake  in  a  violent  hurry  and  agitation,  and 
with  loud  exclamations,  is  a  symptom  sometimes 
observed  in  the  gout,  in  palsies,  and  in  hysteric 
complaints :  it  is  a  very  common  attendant  upon 
pains  of  the  bowels,  worms,  and  convulsive  fits  in 
children  ;  and  when  they  have  started  out  of  their 
sleep  in  this  manner,  they  have  been  above  an 


History  and  Cure  of  Diseases.        141 

hour  before  they  have  perfectly  come  to  them- 
selves. 


CHAPTER  37. 

Febris, 

A  FEVER,  or  general  languidness  mih  a  quick 
pulse,  is  sometimes  an  attendant  upon  other  dis- 
orders, and  will  retreat  in  proportion  &s  they  are 
mitigated  by  their  proper  remedies.  When  it  is 
itself  the  only  distemper,  it  is  still  so  various  in  its 
nature,  that  very  different  methods  of  cure  must 
be  employed  for  different  fevers ;  and  some  part 
of  the  treatment  must  be  learned  from  knowing 
the  patient's  age,  and  constitution,  and  manner  of 
living,  as  well  as  from  a  due  attention  to  the  sea- 
son of  the  year  and  the  peculiar  nature  of  the 
reigning  disease. 

Where  the  fever  is  evidently  inflammatory,  as 
in  the  inflamed  sore  throat,  peripneumonies,  pleu- 
risies, and  inflammations  of  the  bowels,  there  no 
one  can  doubt  of  the  necessity  of  bleeding ;  and 
repeated  bleedings  are  often  required.  The  jail- 
fever,  and  others  which  resemble  it,  seldom  ap- 
pear to  stand  in  need  of  bleeding ;  but  it  is  often 
of  great  importance  in  the  beginning  of  these  fe- 
vers to  clear  the  stomach  and  bowels,  which  is 
pointed  out  by  the  sickness  which  at  that  time 
teazes  the  patient.  This  may  very  properly  be 
done  by  one  scruple  of  ipecacuanha,  joined  with 
one  grain  of  emetic  tartar,  which,  beside  vomit- 


14S  Commentaries  on  the 

ing,  will  generally  occasion  a  few  stools.  The 
sickness  is  usually  so  perfectly  renaoved  by  one 
dose  of  this  medicine,  that  a  second  is  very  rarely 
wanted.  A  head-ach  is  a  very  distressing  symp- 
tom in  the  beginning  of  fevers,  for  which  a  blister 
between  the  shoulders  is  an  almost  certain  reme- 
dy. In  the  inflamed  sore  throat,  pleurisies,  and 
peripneumonies,  blisters  are  likewise  of  great  use 
in  abating  (perhaps  by  diverting)  the  inflamma- 
tion, and  in  all  stages  of  low  fevers,  where  they 
act  as  cordials,  and  stimulate  the  powers  of  life 
to  exert  themselves,  and  to  shake  off  the  languor 
with  which  they  are  oppressed.  The  strangury 
which  they  are  apt  to  occasion  is  certainly  cured 
by  a  clyster  made  of  water  and  oil,  each  two  oun- 
ces, and  fifteen  drops  or  more  of  tinctura  opii. 
In  the  progress  of  the  illness,  if  a  purging  should 
come  on,  the  helps  mentioned  under  the  article  of 
diarrhoea,  must  be  employed  to  check  it.  The 
contrary  state  of  too  great  costiveness  will  be 
best  removed  by  a  clyster  of  half  an  ounce  of  salt, 
and  twelve  ounces  of  water,  with  two  ounces  of 
oil.  Restlessness  and  want  of  sleep,  will  often 
yield  to  fomenting  the  head  and  feet  frequently 
with  flannels  wrung  out  of  hot  water ;  or  two  or 
three  drops  of  tinctura  Thebaica  may  be  given 
every  six  hours.  Heat,  and  thirst,  may  be  allay- 
ed with  lemonade,  or  toast  and  water.  Languor, 
and  excessive  lowness,  may  safely  be  treated  with 
wine  or  cider  mixed  with  water,  or  a  spoonful  of 
the  camphor  julep.  Hiccups,  and  convulsive 
twitchings,  and  agitations,  have  appeared  to  be 
relieved  by  frequently  taking  a  spoonful  of  the 
musk  julep ;  but  though  musk  may  have  some 
virtue  in  quieting  spasms,  and  camphor  has  in 


History  and  Cure  of  Diseases.        143 

some  cases  procured  sleep,  jet  their  effects  are 
neither  great,  nor  constant.  I  have  seen  one 
scruple  of  camphor  given  every  six  hours,  and, 
together  with  this,  one  scruple  of  musk  as  often 
in  the  intermediate  hours :  they  w^ere  both  of 
them  borne  well  by  the  stomach,  but  had  no  per- 
ceivable effect  in  abating  the  convulsive  catchings, 
or  composing  the  patient  to  rest.  While  the  sick 
person  is  in  his  senses,  his  own  inclination,  and 
strength,  will  best  determine  whether  he  should 
sit  up,  or  keep  his  bed,  even  in  the  eruptive  fe<- 
vers,  as  well  as  in  all  others. 

A  specific  in  continual  fevers  is,  1  fear,  still  one 
of  the  desiderata  in  physic,  though  it  has  been 
much  sought  after,  particularly  among  the  prepa- 
rations of  antimony.  In  the  beginning  of  fevers, 
the  safe  antimonial  emetics  and  cathartics  are  un- 
questionably useful ;  but  1  have  never  yet  been 
able  to  satisfy  myself  that  they  do  more  good 
than  would  be  done  by  any  other  equally  strong 
purges  and  vomits.  Many  judicious  physicians 
are  persuaded  that,  in  the  succeeding  stages  of  a 
fever,  antimonial  medicines,  given  in  such  a  dose 
as  just  not  to  vomit  or  purge,  are  efficacious  in 
abating  the  fever,  either  by  bringing  on  a  sweat, 
or  by  some  specific  power.  In  deference  to  their 
judgment,  I  have  directed  four  grains  of  emetic 
tartar  to  be  dissolved  in  four  ounces  of  some  sim- 
ple distilled  water,  of  which  solution  I  have  given 
two  drams,  which  contain  a  quarter  of  a  grain, 
mixed  with  three  spoonfuls  of  water,  every  six 
hours.  This  quantity  is  as  much  as  an  adult  can 
usually  bear  without  being  sick ;  and  where  it  is 
more   than   the  stomach  qan  be  easy  with,  the 


144  Commentaries  on  the 

draught  may  be  divided  into  two  parts,  to  be  ta- 
ken at  the  distance  of  half  an  hour  from  one  an- 
other, instead  of  the  whole  being  taken  at  once. 
Of  this  medicine  I  have  had  considerable  expe- 
rience ;  but  not  enough  to  convince  me  that  anti- 
mony possesses  any  specific  virtue  of  curing  con- 
tinual fevers. 

The  Peruvian  bark  has  been  much  dreaded, 
except  in  a  clear  and  perfect  intermission  ;  but  the 
free  use  which  has  been  made  of  it,  notwithstand- 
ing the  height  of  the  fever,  in  mortifications,  and 
in  other  cases,  where  a  good  suppuration  was 
wanted,  has  taught  us,  that  this  dread  is  as  ground- 
less as  the  many  other  fears  which  people  have 
had  of  this  valuable  simple ;  of  which  the  more 
we  know,  the  less  danger  we  find  of  its  doing  any 
harm,  and  the  more  powers  of  doing  good.  Ac- 
cordingly it  has  been  tried  in  high  continual  fe- 
vers, in  which  I  am  not  so  sure  of  its  being  useful, 
as  I  am  of  its  being  innocent,  not  only  wnen  two 
ounces  of  the  decoction  have  been  given  every 
four  hours,  but  when  two  scruples  or  a  dram  of 
the  powdered  bark  have  been  directed  to  be  ta- 
ken as  often. 

In  every  fever  it  is  of  the  utmost  consequence 
to  keep  the  air  of  the  patient's  chamber  as  pure 
as  possible.  No  cordial  is  so  reviving  as  fresh  airl- 
and many  persons  have  been  stifled  in  their  own 
putrid  atmosphere  by  the  injudicious,  though  well 
meaned,  care  of  their  attendants.  The  English 
seem  to  have  a  very  extraordinary  dread  of  a  per- 
son's catching  cold  in  fevers,  and  almost  all  other 
illnesses;  the  reason  of  which  1  could  never  right- 


History  and  Cure  of  Diseases,      145 

V 

]y  comprehend.  The  sick  do  not  appear  to  me 
to  be  particularly  liable  to  catching  cold  ;  nor  do 
I  know  that  a  cold  would  be  so  detrimental,  as 
not  to  make  it  worth  while  to  run  the  risk  of  it 
for  the  sake  of  enjoying  fresh  air.  I  remember 
one,  who,  being  dehrious  at  the  eruption  of  the 
small  pox,  was  so  unmanageable,  that  by  fre- 
quently throwing  the  clothes  off,  and  being  fre- 
quently naked,  he  catched  a  great  cold,  as  ap- 
peared by  all  the  common  signs  of  one  ;  yet  I 
could  not  observe  that  it  had  any  ill  effect  in  re- 
tarding the  maturation,  or  heightening  the  fever, 
or  preventing  his  recovery.  It  is  often  useful  not 
only  to  keep  the  room  well  ventilated,  but  like- 
wise to  correct  the  bad  air,  by  pouring  vinegar 
on  a  red-hot  shovel,  and  making  the  room  full  of 
the  acid  vapour  which  arises  from  it. 

Very  pale  urine,  unless  the  patient  have  drunk 
a  great  quantity  of  small  liquors,  is  a  bad  sign  in 
fevers,  and  it  is  very  desirable  to  see  it  become 
thick,  and  deposit  a  sediment;  but  I  know  no  oth- 
er use  of  it,  than  the  giving  us  hope  that  the  dis- 
temper is  beginning  to  abate:  nor  am  I  aware 
that  any  important  purpose  can  be  answered  by 
examining  the  faeces ;  for  I  know  no  state  of  them 
which  could  direct  us  to  employ,  or  to  forbear, 
any  particular  method  of  cure. 

For  the  use  of  observing  the  pulse  in  fevers, 
see  the  Medical  Transactions,  vol.  ii.  art.  2. 

In  the  long  and  dangerous  fevers  of  children,  it  is 
very  common  for  them  to  lose  all  power  of  speak- 

19 


146  Commentaries  on  the 

ing  for  many  dajs ;   but  this  is  no  bad  sign,  and 
as  the  fever  abates,  the  voice  always  returns. 

Adults,  as  well  as  children,  are  sometimes  ren- 
dered deaf  for  a  time,  without  any  bad  conse- 
quence. 

Concerning  the  wry-neck  of  children,  see  chap. 
91,  OM  spasms. 


CHAPTER  38. 

Febris  Intermittens. 

The  fit  of  an  intermittent  fever  seldom  lasts 
above  twenty  hours,  and  not  often  so  long.  The 
shivering,  and  sense  of  coldness,  with  which  it 
begins,  will  continue  from  half  an  hour  to  two 
hours;  then  succeed  the  heat,  and  restlessness; 
and  these  yield  to  a  sweat,  the  degrees  of  which, 
and  duration,  are  very  various,  according  as  they 
are  more  or  less  promoted  by  lying  in  bed  and 
drinking  warm  liquors.  The  fit  will  be  a  quoti- 
dian, returning  every  day ;  or  a  tertian,  and  re- 
turn every  other  day  ;  and  if  there  be  the  interval 
of  two  days  between  the  fits,  it  is  called  a  quar- 
tan. Much  longer  intervals  have  been  known; 
but  these  happen  so  seldom,  that  they  have  been 
distinguished  by  no  name,  and  are  not  of  any  im- 
portance to  deserve  our  notice. 

Besides  the  common  appearances  of  fever,  eve- 
ry fit  has  been  sometimes  accompanied  with  oth- 


fistory  and  Cure  of  IHseases.      147 

er  complaints ;  in  some  with  rheumatic  pains ;  in 
several  with  a  light  delirium  ;  in  others  with  an 
eruption  of  the  skin,  or  colic,  or  faintings,  with  a 
pain  and  swelling  of  the  testicles,  a  languidness, 
and  almost  paralytic  weakness  of  the  limbs. — 
These  have  regularly  come  and  gone  with  the  fe- 
ver, and  with  the  cure  of  that  have  finally  disap- 
peared. 

It  is  a  question,  or  rather  perhaps  it  was  a 
question  before  men  knew  well  how  to  cure  an 
intermittent,  whether  they  might  safely  attempt 
to  cure  it.  For  it  was  supposed  to  be  an  effort 
of  the  body  to  relieve  itself  from  some  latent 
seeds  of  mischief,  which  would  shew  themselves 
if  the  intermittent  were  cured.  Some  respectable 
names  in  physic  have  patronised  this  opinion,  and 
i  began  to  practice  with  a  persuasion  of  its  truth: 
but  every  year's  experience  weakened  my  belief 
of  this  doctrine,  and  I  have  long  since,  by  num- 
berless proofs,  been  convinced  of  the  safety  of 
stopping  this  fever  as  soon  as  possible  :  nor  can  I 
doubt  of  having  observed' ill  consequences  where 
the  fever  has  been  suffered  to  remain,  by  delay- 
ing to  use  the  effectual  means  of  preventing  its 
returns.  The  Peruvian  bark  is  the  well-known 
specific,  with  which  Providence  has  blessed  us 
for  the  cuie  of  this  disorder ;  and  if  the  first  fit 
has  been  marked  so  clearly,  as  to  leave  no  doubt 
of  its  being  a  genuine  intermittent,  this  remedy 
should  be  immediately  given  in  such  a  manner,  as 
to  j:)ievent,  if  possible,  a  second.  If  six  drams  of 
powdered  bark  can  be  got  down,  by  taking  a 
dram  at  a  time,  bet'ore  the  hour  of  its  return,  the 
patient  will  find  the  fever  at  least  much  weakerin 


148  Commentaries  on  the 

ed,  if  not  entirely  removed ;  and  the  same  quanti- 
ty taken  four  times  a  day  for  six  days  will  usual- 
ly free  the  patient  from  all  danger  of  a  relapse. 
But  if  this  medicine  be  not  uncommonly  disgust- 
ful, there  may  good  arise,  but  there  can  be  no 
harm,  from  his  taking  it  twice  a  day  for  ten  days 
longer.     This  way  of  using  the  bark  1  think  is 
the  most  to  be  depended  upon ;  but  where  the 
bark  in  substance  cannot  be  taken,  or  borne,  there 
two  ounces  of  a  strong  decoction  used  as  often  - 
will  generally  be  successful.     The  success  would 
be  made  less  uncertain,  if  there  were  no  objection 
from  the  patient's  palate,  or  stomach,  to  the  dis- 
solving in  each  dose  one  scruple  or  half  a  dram 
of  the  extract.     Bark  is  a  difficult  medicine  to  be 
got  down  children's  throats,  especially  in   such 
quantities  as  would  cure  their  agues.     One  scru- 
ple of  the  extract,  and  as  much  sugar,  first  mixed 
with  half  a  spoonful  of  water,  and  then   with  a 
spoonful  and  a  half  of  milk,  is  a  form  which  wfll 
disguise  its  nauseousness  sufficiently  for  many  chil- 
dren to  take  it  Without  any  unwillingness.     But 
wherever  either  in  them,  or  in  adults,  it  cannot 
be  taken  or  borne  in  any  form  upon  the  stomach, 
they  may  still  have   the  benefit  of  it  by  having 
three  or  four  ounces  of  the  decoction  with  one  or 
two  drams  of  the  powder  injected  at  least  twice  a 
day  as  a  clyster ;  and  if  this  should  not  readily  be 
retained,  ten  drops  of  tincture  of  opium  may  be 
added.     It  has  been  proposed  to  cure  an  intermit- 
tent by  keeping  the  feet  immersed  in  a  strong  de- 
coction of  bark :  this  I  have  known  tried  without 
success.     Cases   sometimes   occur   in    which   the 
bark,  though  properly  taken,  will  not  hinder  the 
returns  of  the  fever :  this  is  suspected  to  be  ow- 


I 


History  and  Cure  of  Diseases.       149 

ing  to  a  foulness  of  the  stomach,  which  hinders 
the  bark  from  making  a  due  impression  upon  it ; 
and  therefore  an  emetic  is  given,  and  afterwards 
the  bark  is  repeated  as  at  first.  If  it  still  fail,  a 
scruple  of  camomile  flowers,  powdered,  may  be 
given  in  the  same  manner  as  the  bark,  and  I  have 
known  this  method  more  than  once  succeed  :  I 
have  also  given  in  some  extraordinary  cases  two 
scruples  of  calamus  aromaticus,  and  have  found  it 
more  efficacious  than  a  variety  of  other  means 
which  had  been  previously  directed.  Sometimes 
it  has  been  of  use  to  take  twenty  drops  of  tinc- 
ture of  opium  when  the  fit  is  coming  on. 

A  quartan  ague  is  far  more  obstinate  than  a 
quotidian,  or  tertian,  an,J  will  for  a  long  time 
elude  the  power  of  the  bark  given  in  the  usual 
manner,  and  all  other  remedies.  I  have  found  se- 
veral of  the  inveterate  quartans  yield  to  a  quarter 
of  an  ounce  of  the  bark  taken  just  before  the 
coming  on  of  the  fit.  From  a  persuasion  that  the 
bark  is  dangerous,  if  taken  before  the  fever  has 
perfectly  subsided,  many  begin  to  take  it  with 
very  uneasy  apprehensions,  and  sometimes  will 
too  long  delay  taking  it,  to  their  great  detriment. 
Now  the  only  harm  which  I  believe  would  follow 
from  taking  the  bark  even  in  the  middle  of  the  fit, 
is,  that  it  might  occasion  a  sickness,  and  might 
harass  the  patient  by  being  vomited  up,  and  might 
set  him  against  it;  but  in  nay  judgment  it  can  ne- 
ver be  taken  too  soon  after  the  fever  begins  to 
decline,  provided  the  stomach  will  bear  it. 


150  Commentaries  on  the 

CHAPTER  39. 

Fehris  Heclica. 

A  HECTIC  fever  is  frequently  mentioned  in  the 
writings  of  physicians,  and  likewise  in  common 
conversation  ;  but  the  precise  meaning  of  the  term 
hectic  has  not  been  well  settled,  and  generally 
acknowledged  ;  so  that  probably,  by  different  au- 
thors, it  is  not  always  used  to  express  the  same 
illness.  I  understand  by  it  that  fever,  which  pas- 
ses under  the  name  of  the  irregular  intermittent, 
or  symptomatic,  and  what  usually  attends  great 
suppurations  ;  of  which  it  may  not  be  useless  to 
give  a  short  description,  with  some  mention  of  the 
causes  by  which  it  is  brought  on. 

This  fever  very  much  resembles  the  true  inter- 
mittent, from  which  it  must  be  carefully  distin- 
guished ;  for  their  nature  is  totally  different,  re- 
quiring a  very  different  treatment,  and  the  two 
distempers  are  extremely  unlike  in  the  degree  of 
danger  with  which  they  are  attended. 

In  the  intermittent  the  fits  are  longer,  and  the 
three  stages  of  cold,  and  heat,  and  perspiration, 
are  more  exactly  defined,  and  in  all  the  fits  con- 
tinue nearly  the  same  length  of  time ;  after  which 
there  is  a  perfect  cessation  of  the  fever.  But  in 
the  clearest  remissions  of  the  hectic  there  is  still 
some  quickness  of  the  pulse,  so  as  to  beat  at  least 
ten  strokes  more  in  a  minute  than  it  should  in  a 
healthy  state.  The  fits  also  of  the  hectic  vary 
from  one  another,  seldom  continuing  to  return  in 


I 

I 


History  and  Cure  of  Diseases.       151 

the  same  manner  for  more  than  three  times  to- 
gether. The  shivering  is  sometimes  succeeded 
immediately  by  perspiration,  without  any  inter- 
vening heat ;  sometimes  it  begins  with  heat,  with- 
out any  preceding  cold  ;  and  the  patients  some- 
times experience  the  usual  chillness  without  any 
following  heat  or  sweat.  The  fit  therefore  of  the 
hectic  is  usually  shorter,  but  not  only  because  the 
whole  three  stages  are  shorter,  but  because  one 
of  them  is  often  wanted,  and  sometimes  even 
two. 

The  hectic  patient  is  very  little,  or  not  at  all 
relieved  by  the  breaking  out  of  the  sweat;  but  is 
often  as  restless  and  uneasy  after  he  begins  to 
perspire,  as  he  was  while  he  shivered,  or  burned. 
All  the  signs  of  fever  are  sometimes  found  the 
same  after  the  perspiration  is  over;  and  during 
their  height  the  chilh'ness  will  in  some  patients  re- 
turn, which  is  an  infallible  character  of  this  disor- 
der. Almost  all  other  fevers  begin  with  a  sense 
of  cold ;  but  in  them  it  is  never  known  to  return 
and  to  last  twenty  minutes,  or  half  an  hour,  while 

I  the  fever  seems  at  its  height ;  which  in  the  hectic 
will  sometimes  happen. 
I 


N 


» 


However,  it  is  not  very  unusual  for  the  hectic 
to  have  two  fits,  and  even  three,  as  exactly  resem- 
bling one  another,  as  those  of  a  genuine  intermit- 
ent ;  but  afterwards  they  never  fail  to  become  to- 
tally irregular  :  so  that  1  hardly  remember  an  in- 
stance in  which  the  returns  continued  regular  for 
four  successive  fits. 


The  hectic  in  some  cases  come  on  so  seldom, 
and  is  so  slight,  as  scarcely  to  be  perceivable  for 


±5^  Commentaries  on  the 

ten  or  twelve  days ;  but  in  other  instances,  where 
the  primary  disorder  is  very  great,  the  fever  will 
be  strongly  marked,  and  will  attack  the  patient 
several  times  on  the  same  day,  so  that  the  chilli- 
ness of  a  new  fit  will  begin  as  soon  as  the  perspi- 
ration of  the  former  is  ended.  Several  little 
threatenings  of  a  cold  fit  have  been  known  to  re- 
turn within  a  few  hours. 

In  a  regular  intermittent,  the  urine  during  the 
fever  is  pale,  and  thick  in  the  intervals ;  but  its 
appearance  in  the  hectic  is  governed  by  no  rules; 
so  that  it  will  be  either  clear,  or  loaded,  equally 
during  the  fits  and  in  the  intervals ;  or  even  mud- 
dy in  the  fever,  and  clear  in  its  absence  ;  and  will 
now  and  then,  as  in  common  fevers,  be  pale  dur- 
ing the  attack,  and  muddy  afterwards. 

Beside  the  usual  distress  of  a  fever,  the  hectic 
patient  is  often  harassed  with  pains  like  those  of 
the  rheumatism,  which  either  wander  through  the 
whole  body,  or  remain  constant  and  fixed  m  one 
part ;  and,  what  is  rather  strange,  often  at  a  great 
distance  from  the  primary  malady,  and  in  appear- 
ance unconnected  with  it.  These  pains  have  been 
so  great,  as  to  make  no  small  part  of  the  patient's 
sufferings,  and  to  be  not  tolerable  without  the  as- 
sistance of  opium.  They  are  chiefly  observable, 
as  far  as  I  can  judge,  in  those  whose  hectic  has 
been  occasioned  by  ulcers  in  the  external  parts, 
as  in  cancers  of  the  face  and  breast,  and  in  other 
places  open  to  the  outward  air.  In  some  (ew 
hectic  cases  it  is  remarkable  that  considerable  tu- 
mours will  instantly  arise  upon  the  limbs,  or  body, 


History  and  Cure  of  Diseases.     153 

lasting  only  for  a  few   hours,   without  pain,  or 
hardness,  or  discolouring  of  the  skin. 

There  have  been  those  who  when  they  thought 
liiemselves  tolerably  well  have  suddenly  and  ve- 
hemently been  seized  with  a  {eYC\\  not  unlike  an 
inilammatory  one;  and,  like  that,  seeming  very 
soon  to  bring  the  hfe  into  danger.  However,  af- 
ter a  few  days,  the  distemper  has  abated,  and  the 
patients  have  had  hopes  of  a  speedy  recovery : 
but  these  hopes  have  not  improved  upon  them ; 
for  though  the  first  commotions  have  subsided, 
and  but  little  fever  remain,  yet  this  little,  being 
kept  up  by  some  deep  and  dangerous  cause,  re- 
sists all  remedies,  and  gradually  undermining  the 
health,  ends  only  in  death.  But  this  is  one  of  the 
rarer  forms  of  this  malady  ;  for  in  the  beginning 
it  most  usually  dissembles  its  strength,  making  its 
approaches  so  slowly,  that  the  sufferers  feel  them- 
selves indeed  not  quite  well,  but  yet  for  some 
months  hardly  think  themselves  in  earnest  ill ;  for 
they  complain  only  of  a  slight  lassitude,  and  that 
their  strength  and  appetite  are  a  little  impaired. 
This  state  of  their  health  may  be  judged  not  veiy 
alarming;  but  yet  if  at  the  same  time  the  pulse 
be  found  half  as  quick  again  as  it  should  be,  there 
will  be  great  reason  for  solicitude  about  the 
event.  There  are  not  many  diseases  in  which  an 
attention  to  the  pulse  affords  more  instruction 
than  it  does  in  this  ;  yet  even  here,  whoever  re- 
lies too  confidently  and  entirely  upon  the  state  of 
the  pulse,  will  in  some  cases  find  himself  misled : 
for  it  happens,  as  well  as  1  can  guess,  to  one 
among  twenty  hectic  patients,  that  while  all  the 
powers  of  life  are  daily  declining,  with  every  sign 
20 


154  Conunentaries  on  the 

of  an  incurable  mischief,  the  artery  will  to  the  last 
minute  continue  to  beat  as  quietly,  and  as  regular- 
ly, as  it  ought  to  do  in  perfect  health. 

Great  suppurations  in  any  part  of  the  body  will 
bring  on  this  fever;  and  it  will  particularly  attend 
a  schirrous  gland,  while  it  is  yet  very  little  inflam- 
ed, and  in  the  very  beginning  of  the  inflammation. 
It  increases  in  proportion  as  the  gland  becomes 
more  inflamed,  or  ulcerous,  or  more  disposed  to  a 
gangrene.  Glandular  diseases  are  of  such  a  na- 
ture, that  some  patients  will  linger  in  them,  not 
only  for  many  months,  but  even  for  a  few  years. 

When  a  schirrous  inflammation  is  in  any  exter- 
nal part,  and  obvious  to  the  sight,  or  touch,  or 
when  its  seat  is  in  the  lungs,  or  in  any  of  the  vis- 
cera, whose  functions  are  well  known,  and  cannot 
be  disordered  without  shewing  manifest  signs  of 
the  disease,  in  all  such  cases  we  can  be  at  no  loss 
about  the  cause  of  the  fever.  *But  if  an  internal 
part,  the  uses  of  which  are  not  clearly  known, 
happen,  by  being  diseased,  to  bring  on  hectic 
symptoms,  there  the  fever  which  is  only  symp- 
tomatic, may  he  mistaken  for  the  original  and  only 
distemper. 

Lying-in  vs^omen,  on  account  of  the  mischief 
arishig  from  diflicult  births,  are  liable  to  this  fe- 
ver, and  it  often  proves  fatal.  The  female  sex  in 
general,  after  they  have  arrived  at  their  fiftieth 
year,  are  in  some  danger  of  falling  into  this  irregu- 
lar intermittent :  for  in  that  change  which  their 
constitution  experiences  about  this  time,  the 
glands  of  the  womb,  or  ovaries,  or  of  the  breasts, 


History  and  Cure  of  Diseases,        155 

are  apt  to  become  schirrous,  and  as  soon  as  they 
begin  to  inflame,  the  hectic  comes  on  ;  and  not 
only  these,  but  all  the  glandular  parts  of  the  ab- 
domen, seem  at  this  time  particularly  liable  to  be 
diseased,  and  to  bring  on  this,  of  which  we  are 
speaking,  as  well  all  other  signs  of  a  ruined  con- 
stitution. The  same  evils  are  the  portion  of 
hard  drinkers,  arising  from  the  schirrous  state  of 
the  liver  in  particular,  and  often  of  the  stomach, 
and  other  viscera,  which  are  the  well-known  ef- 
fects of  an  intemperate  use  of  wine  and  spirituous 
liquors. 

The  slightest  wound  from  a  sharp  Instrument 
has  been  the  cause  of  many  distressful  symptoms, 
and  such  as  have  even  proved  fatal.  For  after 
such  an  accident,  not  only  the  wounded  part  has 
been  in  pain  and  has  swelled,  but  other  parts  of 
the  body,  and  those  at  a  great  distance  from  the 
wound,  have  been  affected  with  pain  and  swelling, 
and  have  shown  some  tendency  to  suppuration. 
These  symptoms  never  fail  to  be  joined  by  the  ir- 
regularly Intermittent  fever,  which  continues  as 
long  as  any  of  them  remain.  The  time  of  their 
continuance  is  uncertain  :  some  have  been  harass- 
ed with  them  for  two  or  three  weeks  ;  and  others 
for  as  many  months ;  and,  in  a  few,  they  have 
ended  only  in  death. 

The  hectic  fever  is  never  less  formidable  than 
when  it  Is  occasioned  by  a  well-conditioned  sup- 
puration, in  which  all  the  injured  parts  are  resolv- 
ed Into  matter  so  circumstanced  as  to  be  readily 
discharged  from  the  body. 


156  Commentaries  on  the 

Inflammations  of  scirrhous  glands  in  the  breasts, 
or  in  the  interior  parts,  sometimes  yield  to  reme- 
dies, or  to  nature,  and  together  with  their  cure, 
the  fever,  which  depended  upon  them,  ceases. 
But  these  diseased  glands  much  oftener  end  in 
cancers  and  gangrenes ;  and  the  fever  continues 
as  long  as  any  life  remains. 

It  cannot  be  supposed,  that  a  fever  arising  from 
so  many  different  causes,  and  attended  with  a 
great  variety  of  symptoms,  should  always  require, 
or  bear  to  be  treated  in  the  same  manner. 

As  the  hectic  is  always  occasioned  by  some 
other  disease,  whatever  most  effectually  relieves 
the  primary  malady  must  be  the  best  means  of  re- 
lieving all  its  natural  attendants.  When  the  fever 
has  been  the  consequence  of  some  small  wound,  a 
mixture  of  opium  and  asafoetida  will  prove  an 
useful  remedy.  In  almost  all  other  cases,  the  at- 
tention of  the  physician  must  be  chiefly,  if  not 
wholly  employed,  in  removing  the  urgent  symp- 
toms. A  cooling  regimen  will  temper  the  heat, 
when  it  is  excessive ;  the  bowels  must  be  kept 
nearer  to  a  lax  than  a  costive  state ;  sleep,  if 
wanted,  must  be  procured  by  opium ;  profuse 
sweats  may  be  moderated  by  a  decoction  of  bark 
and  elixir  of  vitriol ;  beside  which,  the  greatest 
care  must  be  taken  that  the  air  and  food,  and  ex- 
ercise, may  be  all  such,  as  will  be  most  conducive 
to  putting  the  body  into  the  best  general  health. 
After  doing  this,  the  whole  hope  must  be  placed 
in  that  power,  with  which  all  animals  are  endow- 
ed, not  only  of  preserving  themselves  in  health, 
but  likewise  of  correcting  many  deviations  from 


History  and  Cure  of  Diseases.        157 

their  natural  state.  And  in  some  happj  constitu- 
tions this  power  has  been  known  to  exert  itself 
successfulij,  in  cases  that  have  appeared  all  but 
desperate.  For  some  patients  have  recovered 
from  this  fever,  after  there  had  appeared  very 
great  signs  of  its  arising  from  some  viscus  incura- 
bly diseased,  where  every  assistance  from  medi- 
cine had  been  tried  in  vain,  and  where  the 
strength  and  flesh  were  so  exhausted,  as  to  leave 
no  hopes  of  any  help  from  nature.  In  this  deplo- 
rable state,  a  swelling  has  been  known  to  arise, 
which,  though  not  far  from  the  seat  of  the  prima- 
ry disorder,  yet  could  not  be  found  to  have  any 
immediate  communication  with  it.  This  tumour 
has  at  length  suppurated,  in  consequence  of  which 
the  pulse  has  grown  calmer,  some  degree  of  ap- 
petite has  returned,  and  all  appearances  of  dis- 
temper have  gradually  lessened,  till  the  strength 
and  health  were  perfectly  restored.  What  in 
some  very  few  instances  I  had  observed  nature 
thus  to  effect,  I  have  endeavoured  to  imitate,  by 
applying  a  blister,  or  by  opening  an  issue,  or  se- 
ton,  near  the  apparent  seat  of  the  internal  mis- 
chief; but  the  success  has  not  answered  my  ex- 
pectations. 

Not  many  years  ago,  in  some  fortunate  recove- 
ries from  mortifications,  the  Peruvian  bark  had 
been  prescribed,  and  had  the  credit  of  the  cure  : 
since  which  time  it  has  been  very  generally  used 
by  practitioners  in  all  tendencies  to  gangrenes, 
and  where  suppurations  had  not  proceeded  in  a 
kindly  manner.  There  is  every  reason  to  believe, 
that  it  may  safely  be  employed  in  such  cases  ; 
and  no  other  remedy  is  known,  which  has  any 


158  Commentaries  on  the 

pretence  to  rival  it  for  these  purposes.  Besides, 
as  the  hectic  fever  is  so  very  like  an  internaittent, 
even  where  there  was  no  suspicion  of  any  gan- 
grene or  ulcer,  the  desires  of  the  sick,  or  of  their 
H'iends,  for  trying  the  bark,  have  been  too  impor- 
tunate to  be  controlled ;  and  physicians  have 
sometimes  prescribed  it  from  iheir  own  judgment. 
But  it  has  greatly  disappointed  all  expectations  of 
benefit  to  hectic  patients  ;  for  it  seems  to  have  no 
efficacy,  where  there  is  no  ulcer ;  and  indeed  it 
has  so  often  been  useless  in  mortifications,  that 
there  may  be  some  doubt,  whether  in  the  prospe- 
rous cases  the  cure  were  not  ovving  to  other  cau- 
ses. 

But  though  I  dare  not  be  confident  that  the 
Peruvian  bark  has  any  extraordinary  virtues  m 
stopping  the  progress  of  mortifications;  yet  1  can 
have  no  doubt  that  it  may  safely  be  used :  for  nei- 
ther in  these  cases,  nor  in  any  other,  have  I  ever 
had  reason  to  suspect  its  doing  harm,  unless  it 
can  be  said  to  do  so  when  it  occasions  a  sickness 
or  diarrhoea,  where  the  stomach  happens  to  be 
weak,  or  the  dose  has  been  too  great,  or  where  it 
has  been  taken  in  hard  boluses,  which  were  not 
readily  dissolved  in  the  stomach  :  and  I  remember 
to  have  heard  Sir  Edward  Hulse  say  the  same, 
who  had  for  above  forty  years  been  giving  as 
much  of  it  as  any  physician  in  England,  and  pro- 
bably much  more  than  any  one  had  given  in  all 
the  other  countries  of  Europe.  Experience  every 
day  more  and  more  confirms  this  testimony  in  fa- 
vour'of  the  bark  :  and  hence  it  must  have  happen- 
ed, that  the  quantity  of  it  used  in  England  for 
the  last  ten  years,  is  ten  times  greater  than  it  was 


History  and  Cure  of  Diseases.        159 

in  the  same  length  of  time  in  the  beginning  of  the 
eighteentJi  century.  It  is  evident,  therefore,  that 
the  more  we  know  of  this  noble  simple,  the  less 
reason  we  find  for  those  suspicions  with  which  it 
was  at  first  calumniated  ;  so  that  it  affords  some 
exception  to  the  general  rule,  u6i  virtus^  ibi  viriis„ 
Yet  we  are  told,  that  many  physicians  are  still 
afraid  of  ever  giving  it  in  the  beginning  of  an  in- 
termittent ;  and  some  are  afraid  of  ever  curing  it 
at  all  with  this  remedy.  They  may  perhaps  ad- 
here to  the  doctrine  (which  I  believe  is  founded 
in  errour,)  that  an  intermittent  is  an  effort  of  na- 
ture, by  which  the  constitution  frees  itself  from 
many  hurtful  humours,  and  from  the  rudiments  of 
many  impending  diseases ;  and  consequently  where 
these  friendly  exertions  are  checked,  those  dange- 
rous maladies  will  fall  upon  the  internal  parts, 
terminating  in  fatal  dropsies.  I  suspect  these 
groundless  fears  have  had  their  origin  from  those 
fevers,  which  were  falsely  judged  to  be  intermit- 
tent, when  in  reality  they  were  hectic ;  and  that 
the  obstructions  in  the  abdominal  viscera  weie 
not  owing  to  the  bark,  but  were  the  original 
cause  of  the  illness. 

In  all  chronical  disorders  which  yield  to  no 
other  remedies,  it  is  usual  for  the  sick  to  be  urg- 
ed by  their  own  hopes,  and  by  the  advice  of  their 
friends,  to  make  trial  of  the  Bath  waters.  Now 
the  inconveniences  of  travelling  and  of  missing 
the  comforts  of  their  own  houses,  must  occasion 
some  additional  sufferings  to  the  sick  ;  and  lor 
these  the  hectic  patients  can  have  no  just  hopes 
of  having  any  amends  made  them  by  going  to 
Bath :  on  the  contrary,  those  waters  would  not; 


160  Commentaries  on  the 

fall,  by  heightening  the  fever,  to  aggravate  all 
their  complaints,  and  to  hasten  their  death. 


CHAPTER  40. 
Fistula  Ani, 

Fistula  ani,  sclrrhi,  and  ulcers  of  the  rectum, 
are  often  attended  with  griping  pains,  tenesmus, 
a  want  and  difficulty  of  making  water,  a  difficulty 
of  retaining  the  stools,  mucous  and  bloody  stools, 
the  stools  always  loose,  or  not  round  but  flatted, 
shiverlngs,  a  swelling,  and  sometimes  a  gangrene 
of  the  testicles,  flying  pains,  and  sometimes  very 
acute  and  fixed  ones  in  a  distant  part  of  the  limbs. 

The  ulcers  which  are  formed  in  the  rectum 
near  the  sphincter  ani  are  often  neglected,  upon  a 
supposition  that  they  are  only  piles  ;  though  the 
pain  of  the  previous  inflammation  be  far  greater, 
and  much  more  Increased  by  coughing  and  sneez- 
ing. Even  after  the  suppuration  has  been  made, 
and  the  ulcer  Is  broken,  the  discharge  from  it.  If 
not  great,  will  still  be  undistinguished  from  the 
piles  ;  for  a  moisture  has  for  a  considerable  time 
continued  to  ooze  out  from  them,  where  experi- 
enced surgeons  upon  examination  have  not  been 
able  to  find  any  ulcer.  However,  where  the  pain 
is  excessive,  or  there  is  any  purulent  discharge, 
the  opinion  of  a  surgeon  is  indispensably  neces- 
sary ;  for,  if  there  be  an  Inflammation  or  ulcer, 
the  whole  care  of  it  belongs  to  him,  and  the  sooner 
he  is  employed,  the  better  it  will  be  for  the  pa- 
tient.    A  timely   use  of  the  proper  means  may 


History  and  Cure  of  Diseases.      161 

hinder  the  forming  of  deep  sinuses,  which  cannot 
perhaps  ever  be  brought  to  a  heahng  condition, 
or  not  without  a  much  more  painful  operation  than 
the  cure  would  at  first  have  cost. 

Fistulous  sores  of  the  rectum  will  remain  un- 
healed, and  keep  discharging  like  a  fontanel  for  a 
long  time  :  one  has  done  so  for  more  than  thirty 
j^ears.  In  some  constitutions  a  previous  unhealth- 
mess  may  make  a  deposit  upon  the  intestine  ;  in 
others  perhaps  a  neglected  ulcer,  arising  from 
slight,  and  merely  local  causes,  may  in  time  taint 
the  whole  body.  Whether  then  we  consider  the 
fistula  as  the  cause,  or  as  the  effect,  it  is  certain 
that  a  bad  state  of  health  is  often  joined  with  a 
fistula  ani,  and  the  mischief,  after  the  cure  of  the 
ulcer,  has  many  times  fallen  upon  other  parts,  and 
particularly  the  lungs,  and  has  brought  on  asth- 
mas, spittings  of  blood,  and  consumptions.  For 
this  reason  it  is  a  common,  and  appears  to  be  a 
reasonable  practice,  to  make  an  artificial  discharge 
by  an  issue,  as  soon  as  the  wound  is  healed,  in 
order  to  drain  oif  any  of  those  diseased  humours, 
which  at  first  occasioned  the  mischief,  or  were 
afterwards  occasioned  by  it ;  and  to  recommend 
such  a  regimen  as  a  consumption  requires. 


CHAPTER  41. 
Fluor  Alhus, 

The  fluor  albus  is  a  weakness  which  has  been 
known  to  incommode  females  in  everv    year  of 

21 


16S  Commentaries  on  the 

their  lives,  from  the  first  to  extreme  old  age ;  but 
it  is  very  rarely  observed  in  children,  and  most 
usually  is  first  heard  of  about  the  time  of  puberty. 

This  discharge,  though  generally  white,  as  the 
name  imports,  and   thin,  yet  has  sometimes   had 
almost  a    jelly-like  consistence,    and  not    unfre- 
quently  a  tinge  of  yellow  :  in  a  few  women  it  has 
been    greenish,   with    an  offensive   smell.      The 
sharpness  of  the  humour  frets  the  parts,  if  not 
duly   washed,  so  as  to  occasion  heat,  itching,  or 
soreness,  and  the  urine  of  course    will  occasion  a 
little  smarting.     It  is  evident   from  this  account, 
that  great  attention   is  necessary   to  distinguish 
this  disorder  from  a  Venereal  infection,  wherever 
there  is  a  possibility  of  its  having  been  commu- 
nicated.    When  a  woman   has  lived  entirely  free 
from  the  fluor  albus,  or  has  had  it  only  in  a  slight 
degree,   and  all  at   once,   upon  cohabiting  with  a 
man  finds  a  great  pain  in  making  water,  and   the 
discharge  suddenly  appear,  or  greatly  increased, 
with  a  deep  yellow  or  greenish  hue,  there  will  be 
strong  reason  to  suspect  an  infection.     It  unluckily 
happens,  that  a  woman  soon  after  marriage  is  par- 
ticularly subject  to  this  disorder,  especially  if  she 
be  of  a   weakly  make,   which    has   often  created 
great  uneasiness,  and   many    disagreeable   suspi- 
cions :  in  these  circumstances  much  caution  is  ne- 
cessary in  passing  judgment   upon  the   nature  of 
the  discharge.     If  the  colour  of  it  remain   white, 
or  at  the  deepest  is  only  of  a  faint  yellow,  and  the 
smarting  of  the  urine  little  or  none,  there  will  be 
no  reason  to  believe  it  more  than  a  simple  weak- 
ness, even  though  the  person   should  never  have 
experienced  any  thing  of  it  before. 


V 


History  and  Cure  of  Diseases.       163 

The  most  common  cause  of  this  malady  is  fre- 
quent miscarriages,  or  lyings-in.  It  has  made 
its  first  appearance,  or  been  increased,  in  ma- 
ny women  during  a  state  of  pregnancy  ;  yet  I 
have  met  with  one,  who  thought  herself  freer  from 
it  at  that  time.  This  flux  has  in  many  instances 
returned  every  month  instead  of  the  menstrual 
one;  or  has  continued  without  ceasing  during  an 
obstruction  of  the  menses,  and  is  not  unusual  in 
elderly  women  just  after  their  final  disappearance. 
A  too  profuse  menstrual  evacuation,  and  this,  will 
often  harass  the  same  subject,  both  of  them  being 
perhaps  owing  to  too  great  weakness.  Too  vio- 
lent exercise,  the  lifting  or  carrying  of  too  great 
weights,  intemperate  venery,  great  disturbances 
of  mind,  and  a  weakly  or  strumous  habit  of  body, 
have  been  no  uncommon  causes.  Whatever  may 
have  been  its  origin,  the  patient  is  sure  to  find  it 
accompanied  with  a  great  pain  of  the  loins,  and  this 
is  not  the  least  part  of  their  sufferings.  Such  a 
constant  drain  must  probably  in  some  measure 
lower  the  health  and  strength,  but  it  is  not  easy 
to  point  out  any  other  ill  consequences.  We  meet 
with  many  women  who  have  had  it  for  a  great 
part  of  their  lives,  and  have  not  been  hindered 
by    it  from  bearing  healthy  children. 

Where  a  weakness  of  the  whole  habit,  or  a  par- 
tial one  of  the  glands  which  supply  this  humour, 
are  judged  to  be  the  only  causes,  the  remedies 
must  be  calculated  to  make  the  whole  body  more 
robust,  or  to  strengthen  the  parts  concerned.  A 
powder  made  of  olibanum  and  Seville  orange  peel, 
each  ten  grains,  with  five  grains  of  oak  bark, 
taken  twice  a  day,  and  washed  down  with  an  in- 


164  Commentaries  on  the 

fusion  of  Peruvian  bark,   has  had  a  good  efifect ; 
and  so  has  a  decoction   of  oak  bark,  in  the   pro- 
portion of  one  ounce  to  a  quart  of  water,  injected 
into  the  vagina  night   and  morning.     These   to- 
gether with  cold   bathing  have  proved  the  most 
powerful  helps.      But  this  disorder,  though  not 
dangerous,  is  often  very  obstinate  from  the  length 
of  time  it  has  lasted,  or  from  some  constitutional 
weakness  ;  and  will  only  admit  of  being  checked, 
and  lessened,    but  never  will  be   entirely  cured. 
Besides,   in  strumous   habits   it   is   not  merely  a 
weakness,  but  a  drain  by  which  part  of  the  nox- 
ious humours  is  carried  off:  this  creates  an  addi- 
tional difficulty  of  curing  it,  and  an  impropriety 
of  attempting  it  merely   by   strengthening  reme- 
dies.    Where  such  have  been  used  in  these  cases, 
and  have  either  stopped  or  considerably  lessened 
the  discharge,  the  patients   have  presently  com- 
plained of  pains  of  the  stomach,  and  have  found 
a  general  illness,  by  which  they  were  far  more 
hurt  than  by  the  former  flux.     To  such  patients 
injections    must   not    be    prescribed ;    instead    of 
which,  together  with  internal  strengthening  medi- 
cines, they  should  twice  a  week  take  some  gentle 
purging  waters,  or  some  of  the  neutral  salts  dis- 
solved either  in  water,  or  in  an  infusion  of  Peru- 
vian bark.     Bristol  water  has  the  reputation  of 
being  useful  in  this  complaint,  which  1  have  no 
reason  to  think  it  deserves.     I  have  known  cases 
in  which  saccharum  Saturni  had  been  used  with- 
out eflecting  a  cure ;  but  if  it  had  been  ever  so 
successful,  the  consequences  of  taking  such  a  dan- 
gerous substance  would  have  been  far  more  pre- 
judicial than  the  distemper. 


History  and  Cure  of  Diseases.       165 

Excruciating  pains  of  the  womb  and  hips  and 
thighs,  which  belong  to  an  ulcer  or  cancer  of  the 
womb,  together  with  the  sanious  and  bloody  ap- 
pearance of  the  gleet,  will  generally  be  sufficient 
to  distinguish  it  from  the  fluor  albus. 


CHAPTER  42. 

Gonorrhoea  Miiis. 

A  GLEET  in  men  resembles  the  fluor  albus  both 
in  its  nature  and  cur;p ;  so  that  very  little  needs 
here  be  added  to  what  has  been  already  said  un- 
der the  last  article.  Such  a  weakness  is  iar  less 
common  in  men,  tharr  in  women ;  being  hardly 
ever  known  in  them,  without  being  owing  to  Ve- 
nereal diseases.  However,  I  have  been  a  witness 
to  two  or  three  cases,  in  which  a  blow  had 
brought  on  a  copious  discoloured  flux,  exactly  re- 
sembling that  from  a  Venereal  infection,  except 
that  it  went  off  spontaneously  in  a  few  days. 

Injections  into  the  urethra  should  be  used  spa- 
ringly, if  at  all,  if  I  am  not  mistaken  in  supposing 
that  the  free  use  of  them  has  been  the  cause  of 
many  strictures,  as  they  are  called,  of  the  ure- 
thra, attended  with  an  extreme  difficulty  and  ex- 
cessive pain  in  making  water,  which  too  often 
prove  an  incurable  torment,  and  end  in  a  fatal 
suppression  of  urine,  or  a  mortification.  An  ab- 
stinence from  the  causes  which  brought  on  the 
gleet,  seldom  fails  to  cure  it,  or  to  reduce  it  so  far 
as  never  to  do  any  material  injury  to  the  health. 


166  Commentaries  on  the 

Yet  many  timid  minds  suffer  more  from  their  ap- 
prehensions of  the  consequences  of  this  complaint 
than  of  any  other ;  and  interested  people  have  en- 
deavoured to  aggravate  those  fears,  in  order  to 
make  an  advantage  of  them  by  the  sale  of  their 
silly  books  and  insignificant  medicines. 


CHAPTER    43. 

Graviditas. 

Most  of  the  complaints-  incident  to  breeding 
women  are  to  be  cured  only  by  their  delivery. 
Women  readily  conceive  a  little  before  the  time 
of  the  menstrual  flux.  Do  they  more  readily  at 
that  time,  than  at  any  other? 

A  healthy  woman  in  the  fifth  month  of  preg- 
nancy began  to  perceive  a  moisture  oozing  from 
the  nipples,  which  continued  till  two  days  before 
her  delivery:  the  breasts  were  then  quite  dry  for 
six  days,  but  on  the  fourth  day  after  the  delivery 
they  were  filled  with  milk. 

I  have  been  told  by  two  married  men,  that  their 
wives  were  free  from  all  Venereal  appetite ;  yet 
they  both  of  them  had  been  pregnant,  and  had 
borne  several  children. 

Pregnancy  is  very  commonly  accompanied  with 
sickness  and  with  the  heartburn  :  where  these 
two  complaints  have  been  excessive,  after  a  va- 
riety of  means  had  been  used  in  vain,  the  sickness 


History  and  Cure  of  Diseases,      167 

has  been  cured  by  rubbing  in  the  anodyne  balsam 
upon  the  region  of  the  stomach,  and  the  heartburn 
by  repeated  doses  of  eh'xir  of  vitriol. 

A  woman  not  suspecting  her  condition,  went  on 
bathing  frequently  for  the  first  months  of  her  be- 
ing with  child,  and  drinking  the  sea  water  so  as 
to  be  purged  two  or  three  times  every  day ;  and 
this  was  the  only  time  she  ever  escaped  a  sick- 
ness, which  she  had  suffered  in  an  uncommon  de- 
gree with  all  her  other  children.  The  juice  of 
oranges  and  lemons,  and  plenty  of  fruit,  have  also 
proved  remedies  for  the  same  sickness. 

A  violent  uterine  discharge  of  blood  has  con- 
tinued for  six  weeks  about  the  sixth  month,  with- 
out occasioning  a  miscarriage.  I  knew  one,  who 
never  ceased  to  have  regular  returns  of  the  men- 
strua during  four  pregnancies,  quite  to  the  time 
of  her  delivery. 

Consumptive  women  readily  conceive,  and  dur- 
ing their  pregnancy  the  progress  of  the  consump- 
tion seems  to  be  suspended  ;  but  as  soon  as  they 
are  delivered,  it  begins  to  attack  them  with  re- 
doubled strength ;  the  usual  symptoms  come  on, 
or  increase  with  great  rapidity,  and  they  very 
soon  sink  under  their  distemper. 

A  difficulty,  or  total  suppression  of  urine,  is 
sometimes  occasioned  by  the  weight  of  the  womb 
pressing  upon  the  urethra,  which  can  only  be  re- 
lieved by  the  catheter.  After  a  suppression  for 
three  days,  upon  introducing  a  catheter,  five  pints 
of  water  came  away      Large  blisters  applied  to 


168  Commentaries  oti  the 

some  pregnant  woman,  who  were  peculiarly  lia^ 
ble  to  the  strangury,  have  occasioned  it  in  so  vio- 
lent a  degree,  as  to  endanger  a  miscarriage. 


CHAPTER  44. 

Hanwrrhoides, 

« 

The  veins  towards  the  extremity  of  the  rectum 
are  hable  to  be  surcharged  with  blood,  in  conse- 
quence of  which  they  sometimes  burst,  and  bleed 
without  any  pain,  like  the  veins  in  the  inside  of 
the  nostrils ;  at  other  times  they  swell  without 
bursting,  to  a  considerable  size  both  within  and 
without,  and  are  in  great  pain  even  after  they 
have  begun  to  bleed.  This  discharge  of  blood  is 
commonly  reputed  to  be  wholesome,  and  the 
checking  of  it  by  forcible  means,  it  is  supposed, 
will  occasion  head-achs,  giddiness,  pains  of  the 
stomach,  and  even  lay  the  foundation  of  a  broken 
state  of  health,  some  great  mischief  being  deposit- 
ed upon  the  vitals  by  that  blood,  which  should 
have  found  an  outlet  through  the  haemorrhoidal 
vessels.'  Now,  we  know  very  well,  that  in  a  per- 
fectly healthy  state  there  is  no  want  of  this  eva- 
cuation, and  wherever  it  happens,  it  may  perhaps 
more  justly  be  called  a  symptom,  than  a  remedy 
of  any  disease. 

In  many  people  the  veins  of  the  rectum  bleed 
from  as  trivial  causes  as  those  of  the  nostrils,  and 
there  is  no  harm  in  neglecting  such  an  haemorr- 
hage.    There  are  several  diseases  of  the  abdo- 


b^  History  and  Cure  of  Diseases.     169 

IBninal  viscera,  which  put  some  obstruction  to  the 
IlKfree  pagsage  of  the  blood  through  them,  and  this 
If  may  probably  occasion  a  breach  in  the  lowest 
part  :  so  we  find  that  in  affections  of  the  liver, 
haemorrhoidal  bleedings  are  very  common,  and 
possibly  may  give  some  little  relief  at  the  time, 
but  are  not  likely  to  contribute  at  all  to  the  cure. 
Bowel  disorders  too  often  prove  fatal ;  and  if  the 
bleeding  of  the  piles  should  have  been  checked 
by  any  applications,  the  mischief  may  falsely  be 
attributed  to  the  want  of  that  evacuation.  I  have 
heard  a  (ew  persons  say,  that  a  head-ach,  an 
asthma,  a  giddiness,  a  redness  of  the  face,  and  a 
pain  of  the  stomach,  had  been  prevented,  or  re- 
moved, by  bleeding  piles.  There  is  some  diffi- 
culty in  determining  whether  they  were  mistaken, 
which  might  easily  happen  ;  but  certainly  the  be- 
■knefits  of  the  piles  are  by  no  means  so  frequent, 
H^nd  so  evident,  as  to  make  any  one  either  wish 
F*  for  them,  or  be  pleased  with  having  them.  There 
is  however  no  very  great  use  in  deciding  the  ques- 
tion of  the  wholesomeness  of  the  piles,  the  bleed- 
ing being  seldom  so  excessive  as  to  threaten  eith- 
er present  danger,  or  future  mischief.  Yet  in 
rare  cases  I  have  known  so  great  a  flow  of  blood 
from  them  every  day  for  a  month  together,  that 
it  unquestionably  weakened  the  patient.  But 
even  in  this  state  of  the  piles,  it  is  hardly  ever 
found  necessary  to  go  beyond  the  use  of  half  a 
pint  of  the  decoction  of  the  bark  taken  at  three 
or  four  times  every  day,  which  perhaps  acts  less 
as  a  styptic,  than  by  obviating  the  ill  effects  of 
such  profuse  bleedings. 
22 


170  Commentaries  on  the 

The  piles  spare  neither  sex ;  they  have  begun 
as  early  as  at  the  age  of  five  years ;  but  they  very 
seldom  molest  children,  and  ma^  rather  be  consi- 
dered as  the  disorder  of  adults.  Women  during 
the  state  of  pregnancy,  and  just  after  the  menses 
have  finally  left  them,  are  peculiarly  subject  to 
the  piles  :  at  all  other  times  they  are  less  troubled 
with  them  than  men. 

The  piles  are  habitual  in  many  constitutions, 
and  have  continued  through  life  with  no  great  in- 
terruption. Both  costiveness,  and  purging  will 
irritate  them.  They  will  not  only  bleed  at  every 
stool,  but  a  serous  moisture  will  constantly  ooze 
out  spontaneously  without  any  ulcer.  The  blood 
does  not  appear  intimately  mixed  with  the  excre- 
ment, but  lying  upon  it.  The  pain  is  greatly  in- 
creased by  going  to  stool,  and  will  last  for  some 
hours  after.  A  heat  of  urine,  a  sickness,  and  pain 
of  the  loins,  are  sometimes,  though  rarely,  com- 
plained of  together  with  the  piles.  Aloes  is  care- 
iully  avoided  in  this  disorder,  as  a  purge  which 
particularly  irritates  the  rectum,  and  not  without 
some  little  reason ;  but  it  appears  to  me,  that  it 
has  not  such  an  effect  so  generally,  and  so  strong- 
ly, as  is  commonly  imagined;  and  it  will  there- 
fore often  disappoint  those  who,  having  a  persua- 
sion of  the  salutary  nature  of  the  piles,  endeavour 
in  some  cases  to  bring  them  on  by  giving  an  aioe- 
tic  purge. 

In  all  bsemorrhoidal  pains  and  bleedings,  the 
body  should  for  evident  reasons  be  kept  in  a  state 
rather  inclining  to  laxity  than  costiveness ;  flow- 
ers of  sulphur  in  the  quantity  of  ten  or  fifteen 


f 


^^ 


History  and  Cure  of  Diseases,        i7i 


ains  have  the  reputation  not  only  of  effecting 
this  in  a  gentle  and  proper  manner,  but  of  having 
some  further  power  of  soothing  the  pain  and  les- 
sening the  discharge  :  however,  it  is  so  doubtful 
whether  sulphur  have  in  this  disorder  any  other 
virtue  than  that  of  a  laxative,  that  there  might 
perhaps  be  safely  substituted  for  it  a  little  leni- 
tive electuary,  or  a  spoonful  of  castor  oil,  or  half 
an  ounce  of  tincture  of  senna  mixed  with  one 
ounce  of  oil  of  sweet  almonds,  all  which  1  have 
seen  used  with  an  equally  good  effect. 

The  pain  is  sometimes  so  excessive  as  to  require 
immediate  relief,  and  this  may  be  procured  by 
means  of  a  cataplasm  of  bread  and  milk  with  a 
little  oil ;  or,  in  a  less  troublesome  way,  by  keep- 
ing the  parts  anointed  with  a  mixture  of  a  dram 
of  the  softened  extract  of  opium  and  two  ounces 
of  any  simple  ointment.  No  facts  have  satisfied 
roe,  whether  opium  act  in  this  case  as  a  topical 
anodyne,  or  in  its  usual  manner  of  affecting  the 
whole  nervous  system  when  applied  to  any  part 
of  the  stomach  or  intestines.  The  pain,  if  occa- 
sioned by  immoderate  distension  of  the  veins,  will 
be  lessened,  or  cease,  upon  their  being  emptied 
either  by  the  point  of  a  lancet,  or  the  application 
of  leeches.  1  have  two  or  three  times  been  assur- 
ed by  haemorrhoidal  patients,  that  a  pint  of  an  in- 
fusion of  box  leaves  taken  night  and  morning  has 
greatly  contributed  to  their  cure  ;  but  I  have  ne- 
ver recommended  them,  because  the  helps  above 
mentioned  appear  sufficient, to  do  every  thing  that 
is  required,  and  with  as  much  expedition  as  th^ 
nature  of  the  case  will  admit. 


« 


17S  Commentaries  on  the 

CHAPTER  45. 

Hernia. 

Ruptures   require   no   other  remedy,   than   a 
proper  bandage,  or  truss. 


CHAPTER  46. 

Hydrocephalus, 

The  heads  of  children  sometimes  grow  enor- 
mously large,  the  sutures  give  way,  and  the  mem- 
branes of  the  brain  are  pushed  up  with  the  water 
within,  and  make  a  soft  tumour  rising  above  the 
edges  of  the  sutures.  This  disorder  happens  to 
weakly  children,  and  has  been  growing  upon  them 
above  a  month.  They  daily  become  more  and 
more  stupid,  with  a  pulse  not  above  seventy-two. 
They  can  hardly  be  got  to  take  any  thing  for  the 
last  week,  even  out  of  a  spoon,  and  seem  to  have 
no  sense,  and  hardly  utter  any  sound,  and  have 
frequent  little  convulsions. 

Upon  opening  a  child  who  died  in  this  manner, 
half  a  pint  of  water  was  found  in  the  ventricles. 
I  have  no  experience  of  the  use  of  any  other 
means  than  purging  and  blistering,  and  these 
have  not  succeeded.  The  subjects  of  the  hydro- 
cephalus are  chiefly  children  of  both  sexes,  from 
the  first  to  the  eighth  year  of  their  lives.  Pains 
of  the  head,  the  hands  frequently  lifted  up  to  the 


History  and  Cure  of  Diseases.        173 

head,  sudden  exclamations,  convulsions,  stupidity, 
deliriousness,  a  slow  pulse,  and  lastly  blindness, 
usually  attend  the  hydrocephalus,  and  make  it 
suspected,  even  without  any  unnatural  enlarge- 
ment of  the  head  ;  but  still  these  are  not  constant 
and  infallible  signs  of  a  dropsy  in  the  head.  No 
unusual  quantity  of  water  was  found  in  the  head 
of  a  child,  who  died  after  suffering  all  these  com- 
plaints. An  adult  was  seized  with  intolerable 
pains  of  the  head,  sometimes  had  a  voracious  ap- 
petite, and  sometimes  none,  became  delirious,  con- 
vulsed, stupid,  and  died  :  the  ventricles  of  the 
brain  were  found  so  distended  with  water,  that  as 
soon  as  a  puncture  was  made  the  water  flew  out 
to  a  considerable  distance. 


CHAPTER  47. 

Hydrophobia, 

I  HAVE  seen  a  considerable  degree  of  the  hy- 
drophobia in  one  whose  throat  had  been  much  in- 
flamed, and  was  suppurated  :  but  I  never  saw  a 
case,  in  which  it  was  the  consequence  of  the  bite 
of  a  mad  animal. 


CHAPTER  48. 

Hydrops, 

{     Swellings  of  the  ankles  or  legs  towards  even- 
ing, which  vanish,  or  are  greatly  lessened  in  the 


174  Commentaries  on  the 

morning,  are  very  common  in  women  while  they 
are  breedin*^,  and  in  hot  weather ;  and  in  both 
men  and  women,  when  they  are  recovering  from 
a  long  illness,  and  in  old  age,  and  after  the  gout, 
or  any  hurt  of  the  legs.  These  swellings  cease 
of  themselves,  or  continue  without  any  danger, 
and  therefore  require  no  medicine.  But  where 
persons  after  having  laboured  for  some  time  un- 
der  complaints  of  the  lungs,  or  of  the  bowels,  be- 
gin to  find  a  swelling  in  the  legs,  it  is  a  sign  of 
some  deep  mischief  in  the  breast  or  abdomen,  the 
swelling  will  most  probably  increase  to  a  just 
dropsy,  and  the  case  end  fatally. 

A  dropsy  is  very  rarely  an  original  distemper, 
but  is  generally  a  symptom  of  some  other,  which 
is  too  often  incurable ;  and  hence  arises  its  ex- 
treme danger.  Water  has  often  been  found  in 
the  thorax ;  but  there  do  not  appear  to  me  any 
infallible  signs  of  a  hydrops  pectoris.  The  na- 
ture of  this  part  hinders  the  swelling  from  being 
perceived  externally,  and  the  respiration  is  not 
oppressed  by  the  water  in  a  manner  so  different 
from  what  it  is  by  other  causes  of  the  asthma,  as 
to  afford  indubitable  signs  of  its  presence. 

A  collection  of  water  in  the  belly  shews  itself 
by  the  swelling,  and  by  the  particular  feel  upon 
gently  pressing  the  belly  with  one  hand,  and  hit- 
ting the  distended  integuments  with  the  other,  by 
which  it  may  generally  be  distinguished  from 
pregnancy,  or  wind,  or  any  enlarged  solid  viscus 
or  gland  ;  yet  I  have  known  very  experienced 
persons  mistaken  in  some  extraordinary  cases. 
The  water  in  the  belly,  called  an  ascites,  is  fr«- 


History  and  Cute  of  Diseases,        17^ 

quently  contained  in  a  cyst  formed  from  a  disease 
ed  gland.  In  women  the  ovaries  very  often  be- 
come the  seat  of  the  dropsy,  which  I  have  known 
to  continue  at  least  ten  years  with  not  much  more 
inconvenience  than  the  bulk  and  weight  must  ne- 
cessarily occasion,  this  part  being  perhaps  less 
necessary  to  life  than  most  of  the  bowels.  I  judg- 
ed it  to  be  the  seat  of  the  dropsy  by  its  beginning 
in  the  region  of  one  of  the  ovaries.  This  dropsy, 
and  some  others  of  the  abdomen,  will  not  be  ac- 
companied with  swelled  legs.  A  very  tormenting 
thirst  attends  the  dropsy  most  usually,  but  not 
universally.  In  every  ascites,  where  the  water  is 
contained  in  a  cyst,  or  cavity  of  the  abdomen,  it 
is  not  easy  to  comprehend  how  it  should  ever  get 
into  the  legs  and  thighs,  after  the  body  had  been 
long  in  an  upright  posture  ;  and  perhaps  it  never 
does ;  the  swelling  of  the  legs  being  occasioned 
by  the  great  weakness  brought  on  by  the  distem- 
per, is  more  properly  of  the  anasarcous  kind,  aris- 
ing from  the  fluid  deposited  in  the  cellular  mem- 
brane, and  not  derived  from  the  water  in  the  ca- 
vity of  the  abdomen. 

It  is  found  a  matter  of  great  difficulty  to  carry 
off  this  stagnating  water,  either  by  purging,  or  by 
increasing  the  urinary  secretion,  and  still  harder 
to  do  it  by  sweat ;  and  when  this  has  been  done, 
it  is  oftener  a  relief  than  a  cure  ;  and  if  no  further 
help  can  be  given  by  nature,  or  art,  towards  re- 
moving the  original  distemper,  the  patient  will  re- 
main in  as  much  danger  as  ever.  Great  care 
must  be  taken  in  ordering  purges  for  these  pa- 
tients, who  are  always  much  weakened  by  the 
distemper;  and  Hot  to  persist  in  purging  them 


176  Commentaries  on  the 

longer  than  their  strength  will  well  bear.  When 
they  are  capable  of  bearing  snch  a  powerful  me- 
dicine, I  choose  to  begin  with  one,  two,  or  three 
grains  of  elaterium,  which  may  be  commodiously 
taken  in  one  spoonful  of  brandy,  or  any  strong 
distilled  water.  If  the  first  dose  evacuate  much 
of  the  water,  without  occasioning  too  great  a  ruf- 
fle, and  so  encourage  us  to  proceed,  it  may  be  re- 
peated twice  a  week,  till  the  water  be  all  carried 
off;  on  the  intermediate  days  some  cordial  bitter 
will  be  the  proper  medicine.  By  this  method  1 
have  cured  four  or  five  dropsical  patients,  one  of 
whom  continued  in  tolerable  health  for  fourteen 
years.  Gamboge,  in  the  quantity  of  half  a  scru- 
ple, may  be  used  in  the  same  manner.  These 
rough  purges  cannot  always  be  borne  or  continu- 
ed, and  then  recourse  must  be  had  to  the  milder, 
with  a  view  at  the  same  time  of  increasing  the 
urine.  For  this  purpose  the  prepared  squills 
may  be  tried,  from  one  to  as  many  grains  as  the 
stomach  can  bear;  and,  if  they  be  given  mixed 
with  the  grateful  aromatic  powders,  or  essential 
oils,  a  large  quantity  may  be  given  without  occa- 
sioning sickness.  Such  a  medicine  may  be  di- 
rected every  night,  and  one  dram  of  diuretic  salt 
in  an  ounce  of  tincture  of  senna  every  morning 
or  half  an  ounce  of  Rochelle  salt  or  soluble  tartar, 
all  these  neutral  salts  being,  as  far  as  I  can  judge; 
from  my  experience,  equally  diuretic. 

The  weakness  of  the  patient,  or  his  disposition 
to  purging,  may  be  such,  as  to  allow  no  room  for 
cathartics,  and  to  admit  only  of  help  from  diure- 
tics. Many  medicines  have  been  delivered  down 
from  former  physicians  as  possessed  of  this  virtue ; 


History  and  Cure  of  Diseases,      177 

but  it  must  be  owned,  that  their  effects  are  too 
uncertain,  and  often  so  slight,  that  whoever  rehes 
much  upon  them,  will  in  most  cases  be  disappoint- 
ed. One  scruple  of  the  active  balsams  has  been 
given  as  a  diuretic  morning  and  night,  and  so  has 
the  same  quantity  of  salt  of  tartar  dissolved  in 
water  or  in  wine,  which  is  a  neater  way  of  em- 
ploying it,  than  to  give  infusions  of  the  ashes  of 
burnt  vegetables,  all  the  activity  of  which  may 
reasonably  be  supposed  to  reside,  not  in  the  insi- 
pid earth,  but  in  their  alkaline  salt,  with  which 
they  abound,  mixed,  in  the  ashes  of  some  plants, 
with  a  portion  of  neutral  salts.  A  dram  of  spiri- 
tus  nitri  dulcis,  or  twenty  drops  of  tincture  of  can- 
tharides,  have  been  used  three  times  a  day  with 
the  same  view  ;  or  a  spoonful  of  the  expressed 
juice  of  artichoke  leaves  mixed  with  two  or  three 
spoonfuls  of  Rhenish  wine. 

When  these,  and  many  others  which  are  reput- 
ed to  belong  to  the  same  class,  have  been  tried, 
as  it  too  frequently  happens,  in  vain,  attempts 
have  been  made  to  draw  out  the  water  by  scari- 
fying the  legs,  or  by  applying  blisters  to  them, 
(little  blisters  will  often  arise  of  themselves,  with- 
out any  application,  upon  dropsical  legs,)  from  all 
which  a  very  considerable  discharge  is  usually 
procured  ;  but  I  have  never  seen  them  cure  the 
distemper,  though  in  some  instances  they  have 
for  a  small  time  checked  its  progress.  Both 
these  methods  are  subject  to  the  inconvenience  of 
making  bad  sores,  notwithstanding  the  legs  are 
fomented  two  or  three  times  a  day,  which  also 
very  much  promotes  the  discharge.  It  is  often 
necessary  to  let  out  the  water  of  the  ascites  by 

23 


178  Commentaries  on  the 

tapping;  the  belly  being  sometimes  so  violently 
distended,  that  the  patient  seems  in  danger  of 
bursting,  and  can  hardly  breathe.  This  opera- 
tion seems  to  carry  off  the  whole  distemper  of  the 
dropsy  :  but  there  have  been  very  few  instances 
within  my  experience,  where  the  water  has  not 
gathered  again,  or  even  where  the  patient  has 
not  died,  though  the  dropsy  never  returned  ;  the 
reason  of  which  is,  what  was  before  mentioned, 
that  the  dropsy  is  a  symptom  only  of  another  dis- 
temper, and  that  most  usually  a  fatal  one. 

In  some  very  rare  cases  the  original  bowel  dis- 
ease takes  a  favourable  turn,  and  the  patient  re- 
covers into  tolerable  health.  Among  the  uncom- 
mon occurrences  in  a  dropsy,  1  have  known  the 
tumour  subside  and  vanish  in  a  few  hours,  by  a 
spontaneous  flux  of  urine  in  an  amazing  quantity  ; 
the  water  by  some  unknown  power  of  an  animal 
body,  having  been  absorbed  from  its  cyst,  and  de- 
posited upon  the  kidneys.  An  event  of  this  sort, 
and  wholly  the  work  of  nature,  may  have  given 
an  undeserved  reputation  to  some  reputed  diure- 
tics, which  had  been  so  lucky  as  to  have  it  hap- 
pen during  their  use. 

I  have  attended  a  few  patients,  who  from  their 
own  judgment  and  choice  have  entirely  abstained 
from  all  liquids ;  which  they  have  been  able  to 
do  for  a  much  longer  time  than  I  could  have  easi- 
ly believed  (at  least  for  forty  days,  and  some  have 
forborne  all  liquids,  as  I  have  heard,  for  six 
months,)  but  not  with  any  success,  which  might 
encourage  others  to  imitate  them.  The  rubbing 
of  the  belly  with  olive  or  castor  oil  night  and 


I 


History  and  Cure  of  Diseases.       i7% 

morning,  has  been  tried  with  as  little  success  by 
many,  because  one  or  two  recovered  who  had 
done  tliis.  Twice  1  have  observed  a  dropsy  spon- 
taneously disappear.  In  one  case  the  patient 
grew  apoplectic;  and  in  the  other  became  deHri- 
ous,  and  died. 

A  man  had  an  ascites,  which  by  a  spontaneous 
and  sudden  discharge  of  urine,  in  a  very  extraor- 
dinary quantity,  totally  disappeared  ;  but  his  legs 
continued  to  swell  for  some  time,  and  kept  him  in 
tear  of  a  return  of  his  distemper.  In  this  state  he 
was  seized  with  an  apoplectic  fit,  from  which  he 
soon  recovered.  From  this  time  he  was  troubled 
with  giddiness,  and  slight  threatenings  of  some  apo- 
plectic mischief;  but  for  many  months  had  no 
swelling  of  his  legs,  nor  any  signs  of  a  relapse  in- 
to the  dropsy. 

There  is  one  species  of  dropsy,  called  anasar- 
ca, which  often  appears  without  being  complicat- 
ed with  any  other  disease ;  and  this  is  frequently 
cured,  and  the  patient  left  in  good  health.  Though 
this  be  for  the  most  part  void  of  danger,  yet  it  it 
not  easily  removed  ;  and  will  for  a  long  time,  not 
only  for  four  or  five  months,  but  even  for  as  man)' 
years,  resist  all  remedies.  Some  apparently  heal- 
thy young  persons  have  had  an  anasarca ;  and  I 
have  several  times  seen  it  in  breeding  women  oth- 
erwise healthy,  and  upon  their  miscarrying  it  has 
disappeared.  It  has  been  acccompanied  in  s.ome 
with  an  extraordinary  flow  of  tears.-  I  have 
known  it  in  all  ages  ;  but  women  are  more  subject 
to  it  than  men.  Gentle  purges,  with  cordial  bit- 
ters on  the  intermediate  days,  are  the  proper  re 


180  Commentaries  on  the 

medies.  The  scarifjing  of  the  legs  has  eflTected 
a  cure ;  and  so  has  an  opiate  given  at  night,  per- 
haps by  the  sweat  which  it  occasioned. 


CHAPTER  49. 

Hypochondriacus  et  Hystericus  Affedus. 

Few  persons,  if  any,  have  been  blessed  with 
such  a  constant  cheerfulness,  as  not  to  have  some- 
times felt  a  languor  and  dispiritedness,  without 
any  manifest  cause,  which  has  cast  a  cloud  over 
all  their  pursuits,  and  has  afforded  only  gloomy 
prospects,  wherever  they  turned  their  thoughts. 
This  state  I  call  the  hypochondriac  affection  in 
men,  and  the  hysteric  in  women.  While  this  is 
in  a  slight  degree,  and  of  short  continuance,  it 
passes  off  unobserved  by  others,  and  is  not  much 
regarded  by  the  sufferer  ;  but  when  the  returns 
of  it  are  frequent,  and  strong,  and  of  long  conti- 
nuance, it  appears  to  be  a  misery  much  harder  to 
be  borne  than  most  other  human  evils,  and  makes 
every  blessing  tasteless  and  unenjoyable.  It  is  a 
sort  of  waking  dream,  which,  though  a  person  be 
otherwise  in  sound  health,  makes  him  {ee\  symp- 
toms of  every  disease  ;  and,  though  innocent,  yet 
fills  his  mind  with  the  blackest  horrours  of  guilt. 

Our  great  ignorance  of  the  connexion  and  sym- 
pathies of  body  and  mind,  and  also  of  the  animal 
powers,  which  are  exerted  in  a  manner  not  to  be 
explained  by  the  common  laws  of  inanimate  mat- 
ter, makes  a  great  difficulty  in  the  history  of  all 


History  and  Cure  of  Diseases.       181 

distempers,  and  particularly  of  this.  For  hypo- 
chondriac and  hysteric  complaints  seem  to  belong 
wholly  to  these  unknown  parts  of  the  human  com- 
position ;  the  body  itself,  as  tar  as  our  senses  are 
able  to  discern,  seeming  to  have  all  its  integrity 
and  perfection  in  those  who  have  long  and  great- 
ly suffered  by  these  disorders.  But  there  is  hard- 
ly any  part  of  the  body  which  does  not  some- 
times appear  to  be  deeply  injured  by  tlie  influence 
of  great  dejection  of  spirits  ;  and  none  more  con- 
stantly than  the  stomach  and  bowels,  which  hard- 
ly ever  escape  unharassed  with  pains,  an  uneasy 
sense  of  fullness  and  weight,  indigestions,  acidi- 
ties, heartburn,  sickness,  and  wind  in  such  an  ex- 
traordinary degree,  as  to  threaten  a  choking,  and 
to  affect  the  head  with  vertigo  and  confusion  :  the 
appetite  however  remains  good,  and  is  sometimes 
voracious.  The  urine  is  most  commonly  pale, 
and  in  great  abundance,  but  not  universally.  No 
distemper  of  the  heart  occasions  greater  palpita- 
tions, than  extreme  lowness  of  spirits,  in  those 
where  the  heart  is  free  from  all  distempers. 
Though  the  lungs  be  sound,  yet  the  respiration 
will  be  performed  with  all  the  tightness  and  op- 
pression of  the  breast  attending  on  an  asthma. 
A  sense  of  fullness  in  the  throat,  and  of  suffoca- 
tion, is  excited  with  as  little  material  cause,  as  far 
as  the  senses  can  judge.  Tears  flow  from  the 
eyes  without  grief;  the  nose  and  ears  are  filled 
with  ideal  odours  and  sounds  :  and  a  mist  will 
seem  to  obscure  the  sight.  A  giddiness,  confu- 
sion, stupidity,  inattention,  forgetfulness  and  irre- 
solution, all  show  that  the  animal  functions  are  no 
longer  under  proper  command,  and  that  the  mind 
is  controlled  by  some  foreign  power.     The  com- 


18^  Commentaries  on  the 

forts  of  sleep  are  in  a  great  measure  denied  to 
these  patients  ;  for  thej  have  but  httle,  and  in  it 
they  are  harassed  with  terrifying  dreams.  Rest- 
lessness, wandering  pains,  sudden  flushings,  cold 
sweats,  a  constant  terrour,  tremours,  catchings, 
numbnesses,  contribute  to  their  misery ;  which 
sometimes  so  overpowers  them,  that  they  either 
sink  under  it  in  a  fainting  {lU  or  it  is  with  great 
efforts  and  struggling  that  they  can  keep  from 
it.* 

All  these  symptoms  are  common  to  hypochon- 
driac men  and  hysteric  women;  but  some  of  them 
are  less,  and  some  more  violent  in  females,  and 
there  are  others  which  seem  peculiar  to  them. 
They  are  seldom  so  low-spirited  ^s  the  men,  but 
are  more  apt  to  have  their  faculties  and  passions 
benumbed,  being  turned  almost  into  statues,  unaf- 
fected by  occasions  of  joy  or  grief.  They  are 
far  more  subject  to  faintings,  and  to  those  univer- 
sal convulsions,  which  are  called  hysteric  fits,  from 
which  the  other  sex  seems  to  be  saved  by  their 
superiour  strength.  These  fits  will  be  brought  on 
by  the  slightest  afTection  of  the  senses  or  fancy, 

*  How  great  a  confusion  of  the  senses  this  disorder  is  capable  of 
producing,  will  appear  by  the  following  history.  A  gentlemen 
about  thirty  years  of  age,  without  any  obvious  cause,  fell  into  a 
great  dejection  of  spirits,  which  lasted  some  time.  At  length,  by 
some  perversion  of  the  mind,  he  seized  a  razor,  and  amputated  bis 
penis  and  scrotum.  After  the  wound  was  healed,  he  said  of  him- 
self, it  appeared  very  strange  to  him  that  he  should  have  courage 
to  perform  such  a  deed,  since  he  was  always  at  other  times  of  so 
timid  a  disposition,  that  he  had  great  dread  even  of  being  bled 
with  a  lancet,  and  could  not  suffer  such  a  trifling  wound  without 
much  agitation.  Yet  he  was  free  f^om  all  fear  when  he  attempted 
this  hazardous  amputation  ;  which  he  moreover  told  me  was  done 
without  his  being  sensible  of  the  least  pain.  A  similar  case  is  re- 
lated in  a  book  entitled  Medical  Communications,  vol.  ii.  p.  54. 


r 

^B  History  and  Cure  of  Diseases,      183 

^B  beginning  with  some  uneasiness  of  the  stomach  or 
bowels.  They  will  last  lor  half  an  hour,  or  less, 
and  return  frequently  every  clay  or  even  continue 
for  a  whole  day  ;  in  the  mean  while  it  is  singular, 
(hat  though  the  hysteric  persons  be  incapable  of 
speaking,  and  seem  senseless,  yet  they  often  hear 
and  understand  every  thing  that  their  attendants 
say.  After  coming  a  little  to  themselves,  or  even 
without  falling  into  a  fit,  they  will  sometimes  have 
a  slight  delirium  upon  them,  which  lasts  for  seve- 
ral hours.  Women  differ  likewise  from  hypo- 
chondriac men  in  being  much  more  apt  to  cry,  and 
to  fall  into  convulsive  laughter,  or  to  lose  their 
voice,  or  utter  violent  shrieks,  and  in  having  hic- 
cups, yawnings,  stretchings  and  other  tendencies 
to  convulsions.  The  hysteric  globe  in  the  throat  is 
scarcely  ever  heard  of  among  men,  but  is  one  of 
the  most  familiar  symptoms  with  hysteric  women. 

Man  has  iraraemorially  been  said  to  consist  of 
S(yft«,  *v>j»j,  Nflw$,  the  body,  the  animal  faculties,  and 
the  mind.  In  hysteric  women  the  operations  of 
the  animal  powers  seem  to  be  most  disturbed  and 
perverted ;  but  in  men  the  mind  is  the  most  affect- 
ed ;  involuntary  exclamations,  faintings  and  con- 
vulsions of  all  sorts,*  being  most  common  in  wo- 
men;  and  silent  despair  in  men.  Hence,  perhaps, 
suicide  is  more  common  with  men,  than  among 
women. 

Some  speculative  persons,  seeing  such  evident 
marks  of  a  design  in  the  author  of  mankind,  that 
human  happiness  in  every  state  should  be  nearly 
the  same,  have  considered  low-spiritedness  as  the 
means  by  which  the  happiness  of  the  rich  and  idle 


184  Commentaries  on  the 

is  reduced  to  a  level  with  that  of  the  indigent  and 
laborious  part  of  the  species.  But  it  is  bj  no 
means  true,  that  the  poor  and  industrious  are  by 
the  lowness  of  their  station  sheltered  from  the  ty- 
ranny of  this  malady.  Some  derive  it  from  their 
parents ;  and  the  seeds  of  it,  brought  with  them 
into  the  world,  are  sure  to  make  their  appearance 
at  the  proper  time,  let  the  condition  of  the  person 
be  what  it  may.  A  dejection  of  spirits  will  rob 
the  poor  husbandman  of  the  ease  and  comfort 
which  he  should  feel  when  the  labour  of  the  day 
is  ended.  Neither  strength  of  constitution,  nor 
temperance,  nor  business,  nor  the  gout,  afford  a 
certain  security.  However,  idleness  will  not  only 
foster  a  disposition  to  a  languor  of  spirits,  but  will 
unquestionably  create  it;  and  so  will  the  other 
extreme,  of  an  oppression  from  too  much  business. 
An  intemperate  use  of  women,  and  wine,  will  like- 
wise be  its  mother  and  nurse,  as  well  as  too  great 
abstinence  in  eating.  Repeated  fevers,  excessive 
purgings,  terror,  and  immoderate  grief,  are  no 
uncommon  causes  of  its  appearance  in  those  who 
before  were  strangers  to  it. 

Hypochondriac  complaints  resemble  the  gout, 
and  madness,  and  consumptions,  in  their  not  ap- 
pearing before  the  age  of  puberty ;  from  which, 
to  the  age  of  sixty,  there  is  no  tiaie  at  which  this 
malady  has  not  made  its  first  visit.  There  are 
very  few  examples  of  low-spirited  persons  who 
find  themselves  worse  at  night  than  in  a  morning; 
the  generality  of  them,  like  most  of  those  who 
are  afflicted  with  any  of  the  complaints  styled  ner- 
vous, are  hurt  by  their  sleep,  little  as  it  is ;  and 
the  longer  they  happen  to  sleep,  the  worse  they 


History  and  Cure  of  Diseases,     185 

are  ;  they  awake  out  of  it  in  confusion,  and  do  not 
come  immediatelj  to  themselves;  and  when  they 
do,  they  can  think  only  of  melancholy  subjects, 
and  feel  the  worst  horrors  of  their  disorder.  This 
state  continues  till  dinner,  with  very  little  abate- 
ment: after  dinner  they  feel  themselves  a  little 
revived ;  and  at  night  the  tide  of  their  spirits  re- 
turns ;  which  being  desirous  to  enjoy,  and  dread- 
ing their  certa?h  ebb  when  they  lie  down,  they  go 
late  and  with  reluctance  to  bed. 

Three  persons  employed  in  examining  and 
smelling  tea,  have  suspected  that  it  occasioned 
tremours  and  other  hypochondriac  ills. 

The  seasons  of  the  year  have  not  appeared  to 
have  any  constant  influence  in  relieving  or  exas- 
perating a  disposition  to  melancholy.  Though 
extreme  dejection  of  spirits  seems  so  nearly  relat- 
ed to  epilepsies,  madness,  and  palsies,  yet  it  is 
not  common  to  see  it  end  in  any  of  these  disor- 
ders. 

It  is  the  condition  of  this  malady  to  make  the 
patient  hopeless  of  a  cure  :  but  neither  reason  nor 
experience  justifies  his  despair.  For  every  part  of 
the  body,  as  far  as  our  senses  can  judge,  is  whole 
and  uninjured  by  his  sufferings,  great  as  they 
are ;  and  the  mind  and  animal  powers  are  indeed 
oppressed,  and  cannot  exert  themselves,  but  their 
abilities  are  all  entire.  Hypochondriac  and  hy- 
steric persons  will  look  well,  and  grow  fat  with 
their  complaints,  and  have  now  and  then  respites 
from  them,  in  which  they  have  all  the  sensations 
of  most  perfect  health.  It  is  well  known,  that 
24 


186  Commentaries  on  the 

some  extraordinary  works  of  genius  have  been 
the  offspring  of  the  intervals  of  melancholy.  This 
malady  will  sometimes  cease  spontaneously ;  and 
1  have  known  it  leave  a  person,  without  any  re- 
turns, for  near  twenty  years.  Now,  what  more 
encouraging  circumstances  can  there  be  in  an  ill- 
ness, than  to  know  that  the  life  is  in  no  danger 
from  it,  that  it  is  not  incurable,  and  that,  when  it 
is  removed,  the  patient  will  becodle  as  perfectly 
well  as  if  he  had  never  experienced  it  ? 

In  the  cure  of  all  chronical  distempers,  it  is  a 
matter  of  great  importance  to  put  the  general 
health,  by  a  proper  regimen,  into  the  best  state 
possible;  by  which  the  self-correcting  principle 
of  an  animal  body  will  be  enabled  to  exert  itself 
with  the  greatest  vigour;  and  this,  in  some  dis- 
eases, is  the  whole  of  what  can  be  done.  This 
therefore  must  be  carefully  attended  to  in  a  lan- 
guid state  of  spirits,  by  avoiding  all  the  general 
causes  of  ill  health,  together  with  all  the  particu- 
lar ones  before  mentioned,  which  may  be  conjec- 
tured to  have  brought  on,  or  to  have  aggravated 
this  malady. 

Evacuations  are  very  ill  borne  in  this  disorder; 
but  as  it  is  usually  accompanied  with  costiveness, 
we  need  not  scruple  to  give  occasionally  three  or 
four  grains  of  Rufus's  pill,  or  a  small  portion  of 
any  other  gentle  aperient  so  as  just  to  procure 
one  motion  every  day ;  for  this  will  mitigate,  or 
prevent  many  of  the  bowel  complaints.  A  gentle 
emetic  may  also  be  sometimes  wanted,  when  the 
stomach  is  uncommonly  loaded  and  sick.  All  fur- 
ther evacuations,  and  particularly  bleeding,  scarce- 


History  and  Cure  of  Diseases.        187 

ly  ever  fail  to  heighten  every  syraptom.  It  is  -so 
little  in  the  power  of  any  medicines  to  give  the 
gout,  and  it  is  so  uncertain  whether  the  gout 
would  take  away  the  hypochondriac  complaints, 
(for  in  some  persons  I  have  known  it  constantly 
bring  them  on,)  that  I  think  it  nugatory  to  attempt 
a  cure  by  giving  any  medicines  which  are  suppos- 
ed to  create  or  to  excite  a  fit.  Bath  waters,  ac- 
cording to  my  experience,  are  at  least  useless,  un- 
less in  some  extraordinary  disorders  of  the  sto- 
mach ;  and  the  going  thither,  or  a  sea  voyage,  or 
foreign  countries,  can  only  be  advisable  when 
they  will  remove  the  patient  from  a  scene  of  grief, 
or  cares,  or  too  much  business.  Sea-bathing, 
and  chalybeate  waters,  may  be  serviceable  upon 
the  same  account;  and  may  besides,  in  some  cases, 
improve  the  general  health.  The  gum-resins, 
and  wild  valerian  root,  and  steel,  have  the  credit 
of  possessing  a  specific  virtue  in  all  maladies  at- 
tributed to  the  nerves  :  my  experience  of  them 
will  not  add  much  to  their  reputation.  The 
nerves  of  the  stomach  and  bowels  have  so  great 
a  dominion  and  control  over  the  whole  nervous 
system,  and  these  parts  are  so  generally  disorder- 
ed in  hypochondriac  and  hysteric  patients,  that, 
in  my  judgment,  the  best  medicines  will  be  such 
as  correct  their  acidities,  and  are  known  by  expe- 
rience to  be  efficacious  in  recovering  them  to 
their  proper  strength  and  functions.  This  pur- 
pose is  best  brought  about  by  the  aromatic  and 
bitter  medicines,  with  which  a  small  proportion  of 
aperients  may  be  joined  when  they  are  wanted. 
These  may  be  given  in  pills,  in  drops,  in  tinctures, 
or  infusions  ;  and  by  this  variety  of  forms,  and  by 
the  small  compass  in  which  they  may  lie,  they 


188  Commentaries  on  the 

may  easily  be  continued,  as  long  as  may  be  neces- 
sary, without  becoming  nauseous. 

Many  in  a  lowness  of  spirits  are  not  indisposed 
to  raise  them  by  wine  and  spirituous  liquors ;  and 
they  are  encouraged  and  pressed  to  do  it  by  their 
well-meaning  but  ill-judging  friends.  No  words 
can  be  too  strong  to  paint  the  danger  of  such  a 
practice  in  its  proper  colours.  The  momentary 
relief  is  much  too  dearly  bought  by  the  far  greater 
languor  which  succeeds ;  and  the  necessity  of  in- 
creasing the  quantity  of  these  liquors  in  order  to 
obtain  the  same  effect,  irrecoverably  ruins  the 
health,  and  in  the  most  miserable  manner.  If  the 
anxiety  of  dejection  becomes  intolerable,  and  must 
have  some  present  relief,  it  is  better  to  seek  it  in 
opium  than  in  wine.  A  few  drops  of  the  tincture 
of  opium,  with  or  without  the  tincture  of  ,asafoe- 
tida,  or  antimonial  wine,  would  be  a  much  safer 
cordial  for  the  drooping  spirits  than  spirituous  li- 
quors ;  and  might  be  increased  without  equal  dan- 
ger of  hurting  the  health,  and  without  bringing 
on  the  same  difficulty  of  ever  leaving  it  off  again. 
My  experience  has  often  taught  me,  how  safely 
and  consistently  with  business,  a  course  of  taking 
opium  may  be  continued  for  a  considerable  part 
of  a  man's  life ;  and  how  practicable  it  is  to  be 
weaned  from  the  habit  of  it :  while  every  body's 
experience  must  have  shown  them  the  danger  of 
persisting  in  a  course  of  drinking  immoderately, 
and  the  almost  impossibility  of  ever  reclaiming  a 
sot. 

1   would   by  no  means  be  understood,  by  any 
thing  which  I  have  said,  to  represent  the  suffer- 


History  and  Cure  of  Diseases.        189 

ings  of  hypochondriac  and  hysteric  patients  as 
imaginary  ;  for  I  doubt  not  tneir  arising  from  as 
real  a  cause  as  any  other  distemper.  However, 
their  force  will  be  very  different,  according  to  the 
patient's  choosing  to  indulge  and  give  way  to 
them,  or  to  struggle  against  and  resist  them,  which 
is  much  more  in  his  power  than  he  is  aware  of, 
or  can  easily  be  brought  to  believe  :  and  it  is 
surely  a  cause  worthy  of  any  one's  utmost  endea- 
vours and  exertions.  For  his  striving  to  shake 
off  this  distemper  is  not  contending  about  a  frivo- 
lous concern,  but  whether  he  shall  be  happy  or 
miserable  ;  since  it  is  of  the  essence  of  this  mala- 
dy to  view  every  thing  in  the  worst  light ;  and  hu- 
man happiness,  in  many  instances,  depends  not  so 
much  upon  a  man's  situation  and  circumstances, 
as  upon  the  point  of  view  in  which  he  contem- 
plates them. 


CHAPTER  50. 

Icterus,  aliique  Hepatis  Affectus, 

The  obstruction  of  the  gall-ducts  from  gall- 
stones is  the  most  common,  but  the  least  dange- 
rous, of  all  liver  complaints ;  for  it  admits  more 
relief  from  art,  and  is  often  surmounted  by  the 
unassisted  efforts  of  nature. 

The  bile,^rom  causes  not  hitherto  clearly  un- 
derstood, frequently  thickens  into  grumous  lumps, 
which  gradually  harden  into  an  almost  stony 
substance.     It   seems  probable  that  these  gall- 


190  Commentaries  on  the 

stones,  as  they  are  usually  called,  are  generally 
formed  in  the  gall-bladder.  This,  I  think,  or  the 
ductus  choledochus  communis,  is  the  place  in 
which  they  are  most  frequently  found,  and  often, 
when  the  liver  is  so  perfectly  sound  as  probably 
to  have  had  no  share  in  producing  them.  At 
least,  it  must  be  owned  that  the  gall-stones  ac- 
quire their  chief  bulk  in  the  gall-bladder,  though 
it  should  be  judged  that  the  nucleus  comes  hither 
from  the  liver. 

The  contents  of  the  gall-bladder  are  naturally 
poured  through  the  ductus  cysticus  and  choledo- 
chus communis  into  the  duodenum.  Together 
with  the  bilis  cystica  the  gall-stones  readily  pass, 
if  they  are  very  small ;  and  if  they  are  large,  they 
sometimes  lie  quiet  in  the  gall-bladder,  without 
being  at  all  perceived,  and  sometimes  make  fre- 
quent efforts  to  get  into  and  pass  the  gall-ducts ; 
in  the  beginning  of  which,  or  in  any  part  of  them, 
if  they  happen  to  be  stopped,  they  of  course  ob- 
struct all,  or  most  of  the  gall,  that  should  flow  in- 
to the  intestines,  which  therelore  is  forced  back 
into  the  liver,  and  thence  into  the  blood,  tinging 
the  serum,  and  consequently  the  skin  and  eyes,  of 
a  yellow  hue,  and  deepening  the  natural  colour 
of  the  urine,  so  as  to  make  it  of  a  very  dark  yel- 
low, or  brown.*  . 

The  usual  symptoms  of  the  gall-ducts  thus  ob- 
structed are,  loss  of  appetite,  sickness,  vomiting, 

*  The  urine  of  one  person  in  a  jaundice,  after  standing  a  few 
hours,  changed  from  a  deep  yellow  to  a  green  colour.  The  same 
change  may  be  observed  in  yellow  bile  a  little  while  after  it  hjis 
been  vomited. 


miory  and  Cure  of  Diseases. 

languor,  inactivity,  sleeplessness,  and  if  the  ob- 
struction be  continued  for  a  few  dajs,  a  very 
great  wasting  of  the  flesh.  These  complaints  are 
remarkable  in  the  obstructed  gall-ducts,  but  they 
belong  to  njany  other  diseases.  The  most  distin- 
guishing signs  of  this  malady  are,  a  yellowness  of 
the  eyes,  skin,  and  urine,  and  a  want  of  this  colour 
in  the  stools.  Nor  is  this  disorder  much  less  cer- 
tainly denoted  in  some  patients,  before  the  yel- 
lowness appears,  by  an  exquisite  pain  about  the 
pit  of  the  stomach,  the  pulse  being  at  the  same 
time  as  slow  as  a  natural  one  :  and  by  an  atten- 
tion to  these  two  circumstances,  it  is  not  difiicult 
to  foretell  the  outward  yellowness,  in  many  cases, 
some  days  before  it  appears.  The  slowness  of 
the  pulse  will  almost  always  distinguish  this  pain 
from  one  which  belongs  to  an  inflammation  of  the 
bowels ;  and  wherever,  together  with  this  pain, 
the  artery  beats  in  the  usual  manner,  the  physi- 
cian will  have  the  great  satisfaction  of  being  able 
to  assure  the  patient,  that  his  pains  can  be  reliev- 
ed, and  that  they  are  not  of  a  dangerous  nature. 

But  this  pain,  which  sometimes  is  hardly  sup- 
portable In  the  jaundice  by  persons  of  the  great- 
est patience  and  courage,  rises  in  others  only  to  a 
slight  uneasiness  about  the  region  of  the  liver,  or 
is  not  felt  at  all.  This  perhaps  may  be  owing  to 
the  difl'erent  parts  of  the  gall-ducts  In  which  tl>e 
stone  happens  to  lodge.  There  is  great  reason 
to  believe  that  the  liver  itself  has  little  or  no 
sense  of  feeling ;  and  it  is  probable  that  not  more 
belongs  to  the  gall-ducts.  But  every  day's  expe- 
rience acquaints  us  how  exquisitely  this  sense  be- 
longs to  the  intestines.     It  may  therefore  be,  that 


19S  Commentaries  on  the 

little  or  no  pain  is  felt  while  the  stone  is  forcing 
its  way  through  the  gall-ducts,  till  it  come  to  the 
end ;  but  in  stretching  that  part  which  is  inserted 
into  the  duodenum,  the  intestine  is,  by  a  large  or 
angular  stone,  distended  or  irritated,  to  a  degree 
which  may  account  for  all  the  torture  that  ever 
attends  the  jaundice.  This  pain  seldom  lasts, 
without  intermission,  above  two  or  three  days ; 
but  I  remember  its  continuing  in  one  person  near 
a  month,  without  any  intervals  of  ease,  except 
what  were  procured  by  opium.  Wherever  this 
pain  is  felt  at  all,  it  not  only  comes  before  the  yel- 
lowness, but  is  sometimes  more,  sometimes  less, 
sometimes  entirely  disappears,  and  then  rages 
afresh,  throughout  the  whole  fit  of  the  jaundice. 

There  sometimes  appears  reason  to  suspect  a 
stone  in  the  ducts  of  the  liver,  from  the  presence 
of  all  the  other  symptoms,  though  there  be  no 
yellowness  in  the  eyes  or  skin ;  which  suspicion 
has  been  verified  by  the  voiding  of  a  gall-stone, 
with  the  relief  of  all  these  symptoms  ;  or  after  fre- 
quent returns  of  them  without  any  discolouring 
of  the  eyes  and  skin,  by  having  one  of  these  fits 
end  at  last  in  a  jaundice.  Whether  it  be,  that  in 
these  cases  the  stone  is  of  such  a  form  as  not  per- 
fectly to  fill  up  the  aperture,  or  that  the  violent 
efiforts  of  vomiting,  without  dislodging  the  stone, 
force  some  bile  between  it  and  the  sides  of  the 
duct. 

And  as  a  gall-stone  may  sometimes  be  suspect- 
ed without  any  marks  of  it  in  the  eyes  or  skin,  so 
this  yellowness  is  said  to  be  found  without  any 
gall-stone  or  prseternatural  consistence  of  the  bile. 


History  and  Cure  of  Diseases,  193 

[t  has   been  supposed   that  an   infraction  of  the 

luodenum  may  be  great  enough  to  hinder  the  ef- 

lux  of  the  bile  :  but  this  may  be  questioned,  if  we 

reflect  that  the  duodenum  has  seldom  any  solid 

jontents  in  it,  and  that  if  it  should  be  so  plugged 

ip  by  them,  or  compressed  by  the  distension  of 

the  other  intestines,  as  to  hinder  the  passing  of 

the  bile,  it  would  for  the  same  reason  be  incapa-' 

ble  of  admitting  any  thing  into  it  from  the  sto- 

lach  ;  which  is  a  supposition  hardly  countenanc- 

id  by  experience. 

Sydenham  mentions  the  jaundice  as  no  uncom- 
Qon  symptom  in  hysteric  cases,  where  there  is  no 
lisorder  of  the  gall  or  gall-ducts.     No  reasona- 
ile  deference  to  this  accurate  observer  can  make 
iny  one  much  doubt  of  his  having  been  mistaken, 
because   nothing  like  this  has  occurred  to  very 
many  other  practitioners,  as   they  have  assured 
me,   though  hysteric  complaints  be  so  very  fre- 
quent :  and  it  requires   but  a  very  moderate  un- 
derstanding to  see,  after  it  has  been  pointed  out, 
what  could  not  have  been  discovered  bui  by  one 
of  superiour  sagacity. 

A  perfect  jaundice  is  said  by  physicians  of  un- 
questionable authority  to  be  an  attendant  upon 
some  fevers,  and  particularly  upon  the  yellow  fe- 
ver of  the  West  Indies.  It  is  also  said  to  be  pro- 
duced by  the  bite  of  a  viper.  And  in  these  cases 
it  is  judged  to  be  owing  to  a  convulsive  stricture 
of  the  duodenum.  Of  all  which  I  am  no  judge, 
as  i  have  never  seen  these  disorders.  There  is 
in  many  exhausted  and  cachectic  persons  a  skin 
almost  of  the  colour  of  a  lemon,  in  which  the  bile 


194  Commentaries  on  the 

is  not  concerned  ;  but  then  they  have  not  yellow 
eyes,  and  dark  urine,  and  ash-coloured  stools, 
which  I  have  never  yet  happened  to  see,  without 
the  strongest  reason  to  suspect  the  gall-ducts  ob- 
structed by  bilious  concretions,  or  scirrhi. 

It  has  long  been  a  prevailing  opinion,  that  eve- 
ry object  appears  yellow  to  the  eyes  of  a  person 
in  the  jaundice  : 

"  Lurida  prseterea  fiunt,  quaecunque  tuentur 
Arquati :" 

is  the  assertion  of  Lucretius;*  and  the  same  has 
been  allowed  by  some  physicians.  Now,  though 
the  tunica  conjunctiva  be  tinged  with  this  ail,  yet, 
as  the  milk  in  the  breast  preserves  its  whiteness, 
it  is  not  probable  that  the  much  finer  humours  of 
the  eye,  through  which  the  light  is  transmitted  to 
the  optic  nerve,  should  ever  be  infected  ;  nor  if 
they  could,  would  it  thence  follow,  that  all  ob- 
jects would  appear  yellow  :  accordingly  all  the 
jaundiced  patients,  whom  I  ever  asked,  have  una- 
nimously denied  the  truth  of  this  pretended  fact ; 
excepting  two  women,  whose  testimony  was  very 
suspicious. 

The  duration  of  the  jaundice  is  extremely  va- 
rious, and  uncertain.  In  some  patients  it  will  dis- 
appear in  two  or  three  days  ;  in  others  I  have  seen 
it  continue  near  a  twelvemonth,  before  the  gall- 
stone could  pass  into  the  intestine,  or  fall  back 
into  the  gall-bladder :  nor  will  this  long  obstruc- 

*  Lib.  iv.  ver.  333- 


History  and  Cure  of  Diseases.       195 

tion  of  the  natural  course  of  the  bile  have  any 
lasting  ill  effects,  or  hinder  the  patient  from  being 
soon  reinstated  in  perfect  health,  after  the  remo- 
val of  the  obstruction.  I  have  known  the  jaun- 
dice return  frequently  for  more  than  twenty  years 
in  some  persons,  who  have  had  good  health  in 
the  intervals  of  the  fits. 

There  is  no  limit  to  the  possible  size  of  gall-stones, 
except  the  capacity  of  the  gall-bladder;  and  they 
are  found  of  all  intermediate  magnitudes  between 
this  and  the  minutest  dust.  When  the  gall-stone 
becomes  too  large  to  enter  the  duct,  it  is  probable 
that  its  lying  in  the  cystis  may  be  attended  with 
some,  though  I  know  not  what,  inconveni?.nce  ; 
but  it  is  often,  we  are  sure,  a  very  slight  one ;  fql* 
many  have  been  opened  after  their  death,  in  whom 
a  very  large  stone,  or  many  small^ones  have  been 
found  without  their  ever  having  had  in  their  life- 
time any  complaint,  which  could  certainly  be  im- 
puted to  this  cause. 

•  I  attended  a  woman,  who  for  five  years  labour- 
ed under  all  the  usual  symptoms  of  the  jaundice 
in  the  highest  degree.  In  the  sixth  jear  she  void- 
ed a  gall-stone  like  a  small  olive  in  shape  and  size; 
after  which  she  enjoyed  good  health  for  many 
years  without  any  return  of  jaundice,  or  the  ap- 
pearance of  a  disorder  which  could  be  imputed 
to  her  once  having  had  it.  The  passing  of  such 
large  stones  shews  what  great  efforts  nature  is 
capable  of  making  towards  freeing  itself  from  such 
an  incumbrance.  The  natural  size  of  the  gall- 
duct  hardly  exceeds  that  of  a  goose-quill ;  and  a 
force  may  be  exerted  which  will  distend  this  nar- 


J  96  Commentaries  on  the 

row  passage  so  as  to  let  a  stone  pass,  the  smallest 
circumference  of  which  equals  two  inches  :  I  speak 
only  of  what  I  myself  have  seen :  others  give  us 
accounts  of  the  passing  of  much  larger.  In  the 
gall-duct  of  one  woman,  whom  I  had  attended, 
there  was  found  after  death  a  gall-stone  as  big  as 
a  small  hen's  egg. 

I  have  had  an  opportunity  of  examining  the 
gall-ducts  of  some,  whom  I  had  frequently  seen  in 
fits  of  the  jaundice ;  and  I  found  them  much  dis- 
tended beyond  their  natural  diameter  throughout 
their  whole  length,  but  very  unequally.  The 
same  appearances  are  very  common  in  the  urelers 
of  those,  who  have  had  many  stones  pass  from 
the  kidneys  to  the  bladder.  The  liver  of  these 
persons,  though  they  bad  for  many  years  suffered 
frequent  fits  of  the  jaundice,  was  perfectly  sound. 

It  is  frequently  recommended  to  the  attendants 
upon  icteric  patients  to  examine  their  stools,  in 
order  to  find  the  gall-stones,  and  there  can  be  no 
reason  to  hinder  them  from  doing  it;  but  the  oth» 
er  signs  of  this  disorder  are  so  certain,  that  the 
finding  of  a  gall-stone  will  add  very  little  to  the 
evidence  for  the  nature  of  the  disorder,  and  will 
be  of  no  use  to  the  cure.  For  whether  a  gall- 
stone be  found  or  not,  the  method  of  cure  must 
be  continued  as  long  as  the  symptoms  remain,  by 
which  alone  the  physician  must  be  directed.  Let 
there  be  ever  so  many  gall-stones  found,  if  the 
patient  be  not  relieved,  it  must  be  supposed  that 
more  remain  ;  and  consequently  the  same  medi- 
cines must  be  continued  :  and,  on  the  other  hand, 
though  there  be  none  found,  if  all  the  complaints 


History  and  Cure  of  Diseases.       197 

cease,  the  probability  is  that  the  stone  is  fallen 
back  into  the  c}  stis,  and  therefore  little  or  no- 
thing more  is  to  be  done. 

Some  gall-stones,  which  I  have  weighed,  have 
been  heavier  than  water,  and  others  have  been  to 
water  as  nine  to  ten.  They  melted  also  by  heat, 
and  were  inflammable.  1  have  examined  only  a 
few  in  this  manner ;  and  possibly  there  may  be  a 
great  difference  between  these  and  others,  in  the 
texture  and  materials  of  which  they  are  compos- 
ed :  most  of  what  I  have  seen  were  of  a  dark 
brown  colour,  but  some  have  been  almost  white 
externally,  though  brown  within. 

A  very  troublesome  itching,  but  without  any 
eruption,  is  often  observed  in  the  jaundice  :  this  is 
supposed  to  be  owing  to  the  irritation  of  the  skm 
from  the  acrimony  of  the  bile  mixed  with  the 
blood  :  but  it  is  not  easy  to  say,  why  this,  or  any 
other  cause,  should  make  this  complaint  so  ex- 
ceedingly distressful  to  some,  whilst  it  is  not  at 
all  felt  by  others. 

In  a  simple  jaundice,  without  any  apparent  dis- 
order of  the  liver,  or  other  viscera,  a  hiccup  will 
now  and  then  join  itself  to  the  other  symptoms, 
but  without  denoting  any  present  or  future  mis- 
chief. 

It  might  naturally  be  expected,  that  the  want 
of  irritation  from  the  bile  should  make  icteric 
persons  costive  ;  but  in  fact  they  are  often  dispos- 
ed to  have  a  purging.  Certainly  neither  of  these 
states  is  peculiar  to  their  distemper;  and  the  spon- 


198  Commentaries  on  the 

taneous  diarrhoea,  or  the  readiness  with  which  a 
costiveness  is  removed,  may  help  to  distinguish  it 
from  the  ileus. 

In  other  disorders  of  the  bowels,  it  is  a  very 
alarming  symptom,  to  have  the  patient  subject  to 
fits  of  shivering :  but  very  strong  ones  now  and 
then  happen  in  the  jaundice,  and  last  an  hour,  and 
return  every  day  for  two  or  three  times,  without 
being  followed  by  any  other  complaint.  It  is  dif- 
ficult to  guess  satisfactorily  at  the  cause  of  this: 
but  whatever  it  be,  I  have  suspected  that  this 
symptom  happens  at  the  time  of  the  stone's  pass- 
ing into  the  intestines.  However,  neither  suppu- 
ration, nor  gangrene,  nor  any  other  mischief, 
needs  be  apprehended  from  this  shivering. 

It  is  not  constant  in  this  malady,  but  it  is  far 
from  being  uncommon,  to  have  all  solid  food  taste 
bitter ;  and  sometimes,  though  more  rarely,  the 
same  is  true  of  liquids.  I  knew  one,  to  whom  all 
liquids,  and  solids,  tasted  bitter,  except  oysters. 

The  milk  of  icteric  women,  who  suckle  chil- 
dren, is  not  tainted  with  the  bile,  either  in  its  co- 
lour or  taste.  I  remember  to  have  seen  a  wo- 
man, v?jho  with  a  very  deep  jaundice  had  been  for 
six  weekr,  suckling  a  child,  who  sucked  with  ea- 
gerness, and  was  healthy -and  robust.  One  man 
assured  me  his  tears  were  tinged  in  a  jaundice. 

Infants,  and  children  of  all  ages,  are  subject  to 
the  jaundice  ;  but  they  have  it  in  a  slight  manner, 
and  soon  recover  from  it ;  and  it  does  not,  as  far 
as  I  have  observed,  do  them  any  hurt.     Men  and 


History  and  Cure  of  Diseases.     199 

women  seem  equally  liable  to  this  malady  :  m  a 
continued  succession  of  a  hundred  {jatients,  I 
counted  fifty-two  males,  and  forty-eight  females. 

They  who  have  once  had  this  distemper,  are 
very  liable  to  returns  of  it ;  not  only  because  oth- 
er gall-stones  are  likely  to  be  generated  by  the 
same  causes  which  formed  the  first,  but  likewise 
because  a  fit  of  the  jaundice  is  frequently  termi- 
nated, not  by  the  passing  of  the  stone  into  the 
duodenum,  but  by  its  falling  back  into  the  cystis ; 
at  its  passing  out  of  which  it  occasions  a  fresh  fit; 
and  many  may  be  thus  caused  by  the  same  stone. 

A  jaundice,  caused  merely  by  an  obstruction 
of  the  gall-ducts  by  a  stone,  is  usually  void  of  all 
danger ;  so  that  many  people  are  not  hindered  by 
it  from  doing  all  the  common  business  of  life, 
where  no  great  exertion  of  strength  is  required. 

Very  different  is  the  danger  in  diseases,  which 
properly  belong  to  the  liver  itself.  This  viscus 
seems  in  some  instances  to  have  been  seized  with 
a  sudden  and  violent  inflammation,  joined  with  a 
fever,  and  with  signs  of  immediate  danger;  which 
are  neither  followed  by  a  speedy  death,  or  by  a 
lingering  one,  after  an  unkindly  suppuration, 
which,  though  more  slowly,  yet  is  scarce  less  cer- 
tainly fatal.  Such  an  inflammation  perhaps  more 
usually  begins  in  some  of  the  parts  to  which  the 
liver  is  contiguous,  and  is  communicated  to  it 
from  them.  But  what  I  have  conjectured  to  be 
this  distemper  of  the  liver,  has  rarely  occurred  to 
me,  in  comparison  of  that  which  begins  here,  as 
in  other  glandular  parts,  with  a  small  scirrhus. 


200  Commentaries  on  the 

which  gradually  spreads  itself  over  its  whole  sub- 
stance, and,  I  imagine,  just  in  the  same  manner  as 
it  happens  in  the  breasts  of  wonjen. 

These  scirrhi  by  fits  inflame,  whence  a  fever  is 
raised,  and  the  health  in  many  respects  much  dis- 
composed. This  fever  retreats  on  the  abatement 
of  the  inflammation,  and  the  patient  is  encouraged 
to  hope  for  a  recovery  ;  but  his  hopes  are  usually 
vain ;  the  intervals  between  these  inflammations 
becoming  shorter,  the  appetite,  flesh,  and  strength 
decreasing  with  a  little  cough  and  hiccup,  which 
sometimes  without,  and  often  with  a  dropsy, 
bring  on  death ;  towards  which  the  progress  in 
different  patients  is  so  unequal,  as  either  to  take 
up  several  years,  or  to  be  finished  in  a  few 
months. 

The  liver  having  but  a  very  dull,  if  any,  sense 
of  feeling,  if  the  inflammation  be  confined  to  the 
interior  parts,  it  will  hardly  be  attended  with  any 
pain;  which,  as  I  suspect,  is  never  perceived,  but 
when  an  ulcer,  or  inflammation  of  the  surface  of 
the  hver,  catches  the  diaphragm,  intestines,  or 
parietes  of  the  abdomen.  In  this  state  of  the 
liver  the  patients  choose  to  lie  on  their  right 
side. 

A  pain  of  the  right  shoulder  is  common  in  liver 
cases  ;  but  on  what  circumstances  it  depends,  no 
observations  have  yet  ascertained  to  me ;  nor 
whether  it  belono-s  to  a  mere  obstruction  of  the 
gall-ducts,  or  only  to  scirrhous  inflammations  of 
this  part ;  which  last  I  rather  suspect. 


History  and  Cure  of  Diseases.       aoi 

In  the  advanced  state  of  these  scirrhi,  the  blood 
will  gush  out  in  great  quantities  from  the  nose, 
the  gums,  the  stomach,  the  navel,  and  with  the 
stools ;  which  is  probably  to  be  attributed  to  the 
obstruction  which  it  meets  with  in  the  scirrhous 
liver. 

The  worst  of  these  cases,  of  which  I  have  satis- 
fied myself  by  seeing  the  bodies  opened,  will 
sometimes,  throughout  their  whole  course,  shew 
no  signs  of  a  jaundice ;  that  is,  though  the  com- 
plexion may  be  of  a  leaden  colour,  yet  the  skin 
and  eyes  and  urine  will  be  free  from  the  jaundice- 
tincture,  and  the  stools  will  not  be  ash-coloured. 
The  reason  of  which  may  be  this  ;  that  the  diseas- 
ed parts  of  the  liver  are  so  situated,  as  not  to  in- 
tercept the  course  of  the  bile  in  its  passage  from 
the  sounder  parts  to  the  duct. 

An  indurated  liver  is  often  very  evidently  dis- 
tinguishable by  applying  the  hand  to  the  region 
of  it :  and  this  affords  another  certain  sign  of  its 
diseased  state.  These  are  the  only  peculiar 
signs,  that  this  viscus  is  the  seat  of  any  malady ; 
for  the  quick  pulse,  hiccup,  sickness,  and  averse- 
ness  from  food,  equally  belong  to  the  distemper 
of  the  liver,  and  of  many  other  viscera.  I  doubt 
indeed  whether  it  be  of  any  great  moment  to  be 
able  to  decide  with  preciseness,  whether  the  ail 
be  here,  or  in  the  pancreas,  or  spleen  :  for  I  know 
of  no  remedy  peculiarly  or  specifically  appropri- 
ated to  this  state  of  the  liver ;  and  there  is  not 
much  more  to  be  done  in  it,  than  what  the  com- 
mon cure  of  the  hectic  fever  requires,  whether 
the  fever  arise  from  this,  or  from  any  other  cause. 
26 


S0»  Commentaries  on  the 


It  is  probable,  if  a  small  part  only  of  the  liver 
be  scirrhous,  that  it  maj,  by  a  cool  regimen,  and 
by  assisting  the  general  health,  be  kept  for  many 
years  from  spreading. 

Where  frequent  inflammations,  with  a  conside- 
rable degree  of  fever,  cannot  be  prevented,  there 
the  flesh  and  strength  more  rapidly  decrease ; 
and  if  the  inflammation  be  great  enough  to  occa- 
sion a  suppuration,  the  only  chance  of  a  recovery 
is  from  the  breaking  of  the  abscess  in  such  a  man- 
ner, as  that  the  matter  may  be  carried  off  by  the 
hepatic  duct,  or  when  the  inflammation  of  the  li- 
ver has  made  it  adhere  to  the  parietes  of  the  ab- 
domen, in  which  a  tumour  forms,  and  is  opened, 
or  burst,  externally.  I  have  known  one  or  two 
recover  in  such  circumstances,  but  more  who 
have  sunk.  In  some,  a  great  abscess  of  the  liver 
has  appeared  to  have  made  its  way  preternaturally 
into  the  stomach,  or  bowels ;  and  immediately, 
upon  the  bursting  of  it  into  these  parts,  the  pa- 
tients void,  by  vomiting  and  purging,  a  most  of- 
fensive matter,  filling  a  whole  house  with  its  noi- 
some smell,  and  die  in  a  few  hours. 

A  woman  fifty  years  of  age  was  for  ten  days 
severely  afflicted  with  pain  of  the  stomach,  hic- 
cup, purging,  and  faintings,  and  with  difficulty 
struggled  through  it.  A  month  after  there  arose 
a  swelling  near  the  navel,  which  was  opened,  and 
discharged  a  great  quantity  of  yellow  fluid  for  the 
space  of  four  years;  at  length  the  pain  increased, 
together  with  sickness,  and  shivering,  and  after  a 
few  days  there  was  discharged  a  gall-stone  three 


History  and  Cure  of  Diseases.       SO 3 

inches  long  and  as  much  in  circumference,  weigh- 
ing 245  grains.  During  the  two  following  weeks 
a  thin  liquor  was  poured  out  in  great  abundance: 
soon  after  the  sore  healed  up,  and  the  woman  re- 
covered. It  is  evident  the  gall-bladc(er  must  in 
this  case  have  inflamed  and  suppurated. 

A  sudden  inflammation  of  the  parts  contiguous 
to  the  liver,  by  which  it  would  soon  be  aflected, 
or  possibly  of  the  liver  itself,  may  be  occasioned 
by  any  of  the  causes  to  which  pleurisies  and  simi- 
lar disorders  are  owing.  The  more  chronical 
diseases  of  the  liver,  which  begin  with  small  scir- 
rhi,  arise  sometimes  from  the  same  ill  habit  of  bo- 
dy which  occasions  scirrhi  in  other  glandular 
parts,  or  from  a  blow ;  but  the  most  common 
cause  is  an  intemperate  use  of  spirituous  liquors, 
which  specifically  hurt  the  liver,  far  more  than 
they  do  the  stomach,  to  which  they  are  immedi- 
ately applied,  or  than  they  do  any  other  of  the 
bowels. 

Men  are  more  commonly  affected  with  scir- 
rhous livers  than  women,  because  they  are  more 
given  to  intemperate  drinking,  which  is  the  prin- 
cipal cause  of  this  disorder. 

Bath  waters  are  in  no  cases  more  useful,  than 
in  remedying  many  of  the  injuries  done  to  the 
constitution  by  drunkenness :  but  where  the  liver 
is  become  scirrhous,  and  a  hectic  fever  shews 
these  scirrhi  to  be  in  an  inflamed  state,  there  the 
Bath  waters  will  aggravate  all  the  symptoms, 
and  contribute  no  otherwise  to  end  the  disease 
than  by  hastening  the  patient's  death. 


304  Commentaries  on  the 

In  the  cure  of  those  whose  gall-ducts  are  ob- 
structed bj  biliary  concretions,  the  first  thing  to 
be  attended  to,  is  the  pain ;  which  is  often  so  ex- 
cessive, that  nothing  else  ought  to  be  attempted, 
before  this  is  relieved.  Bleeding  is  here  of  no 
use,  and  should  therefore  be  forborne  as  a  need- 
less waste  of  strength.  This  pain  can  only  be 
assuaged  by  giving  and  repeating  opium,  or  its 
preparations,  as  often  as  the  continuance  of  the 
pain  requires  them.  And  because  this  pain  is 
very  apt  to  return,  the  patient  should  always  be 
advised  to  keep  by  him,  as  long  as  the  distemper 
lasts,  pills  of  pure  opium,  each  weighing  one 
grain,  or  what  is  equivalent  to  them,  that  no  time 
may  be  lost  in  quieting  a  sensation  which  it  is  so 
difficult  to  endure.  One  of  these  pills  may  be  ta- 
ken as  soon  as  the  pain  comes  on ;  and  it  may  be 
repeated  once  or  twice  in  the  space  of  two  hours, 
if  the  pain  requires  it.  1  have  found  it  both  safe 
and  necessary  to  give  much  more. 

Vomiting  is  commonly  the  next  symptom  which 
demands  the  physician's  assistance.  This  seems 
to  be  an  effort  of  nature  to  dislodge  the  stones ; 
but  it  may  be  a  question,  whether  it  be  such  an 
effort  as  ought  to  be  encouraged,  or  checked  ;  for 
though  on  the  one  hand  this  violent  concussion 
may  force  the  stone  back  into  the  cystis,  or  for- 
ward into  the  duodenum,  and  so  effect  either  a 
temporary  relief  or  a  perfect  cure,  yet  it  may  be 
feared,  if  the  stone  be  so  fixed  in  the  duct,  as  not 
to  be  easily  moved,  that  the  action  of  vomiting 
will  lacerate  the  membraneous  duct,  and  be  the 
cause  of  future  mischief,  as  well  as  of  present 
pain.     Now,  whether  this  fear  be  just,  or  ground- 


History  and  Cure  of  Diseases,        205 

less,  can  only  be  determined  by  experience ;  and 
by  what  I  have  observed  of  icteric  cases,  it  has 
appeared  to  me,  that  a  vomit  excited,  while  the 
pain  was  intense,  has  rather  quieted  than  aggra- 
vated it,  and  has  never  brought  it  on.  But  if  we 
be  secure  of  its  doing  no  harm,  there  is  so  good  a 
chance  of  its  being  beneficial,  that,  whether  the 
patient  have  a  vomiting  or  not,  it  is  a  judicious 
practice  to  order  an  emetic,  either  at  first,  or  as 
soon  as  the  intenseness  of  the  pain  has  been  alle- 
viated, and  occasionally  to  repeat  it.  To  excite 
a  vomiting  in  this  malady  is  much  moie  easy  than 
to  stop  it ;  and  therefore  it  is  always  proper,  and 
sometimes  necessary,  to  order  an  opiate  to  be  ta- 
ken after  a  moderate  number  of  strains  have  been 
procured,  or  if  the  sickness  continue  longer  than 
usual. 

Similar  good  effects  may  with  reason  be  expect- 
ed from  purging  medicines,  by  their  increasing 
the  natural  motion  of  the  intestines,  and  soliciting 
a  greater  flow  of  bile,  as  well  as  of  all  the  other 
humours  which  are  poured  into  them.  Mercurial 
purges  have  been  preferred  by  some  practition- 
ers :  but  there  appears  nothing  in  the  known  pow- 
ers of  mercury  peculiarly  useful  in  dislodging  a 
biliary  concretion  ;  and  the  preference  should  be 
given  to  those  purges  which  act  with  the  most 
ease,  and  may  be  continued  with  the  greatest 
safety.  Such  are  the  sea-water,  the  water  of  ma- 
ny purging  springs,  as  also  many  of  the  neutral 
salts,  dissolved  either  in  water,  or,  if  it  can  be 
borne,  in  a  weak  infusion  of  some  bitter  vegeta- 
ble substance.  These,  as  we  know  by  abundant 
experience,  may  be  taken  for  several  months,  ei- 


S06  Comtnentaries  on  the 

ther  every  day,  or  every  other  day,  without 
ing  the  appetite,  or  exhausting  the  strengtli  or 
spirits.  But  in  some  cases  there  may  be  reason 
for  using  other  purgatives ;  and  I  have  known  a 
few  grains  of  rhubarb,  or  one  or  two  drams  of 
tincture  of  senna,  or  of  rhubarb,  taken  with  ad- 
vantage in  a  small  draught  of  some  moderately 
bitter  infusion.  The  jaundice  of  infants  and 
young  children  soon  yields  to  a  few  purging  me- 
dicines. 

If  it  happen  that  the  jaundice  is  of  itself  attend- 
ed with  a  purging,  there  may  be  nothing  further 
necessary,  than  by  gentle  means  to  prevent  its 
being  excessive,  and  at  the  same  time  to  strength- 
en the  stomach  by  proper  bitters. 

The  itching  is  many  times  so  extremely  trou- 
blesome, as  to, require  opium;  without  the  help 
of  vi'hich  it  would  be  impossible  to  procure  any 
ease  or  sleep. 

Beside  these  medicines,  which  have  appeared 
to  me  the  most  beneficial  of  any  which  I  have 
seen  used,  there  is  a  class  of  bodies  which  have 
been  trusted  to,  from  a  belief  that  they  have  a 
power  of  dissolving  gall-stones.  Of  this  kind  are 
the  alkaline  salts,  lime-water,  soap-leys,  and  va- 
rious soaps  :  all  which  I  have  tried  by  steeping 
gall-stones  in  soap-leys,  and  lime-water,  and  in 
the  solutions  of  soap,  and  of  the  salts ;  and  it  is 
no  wonder,  that  the  others  did  nothing  towards 
dissolving  the  stones,  when  the  most  powerful  of 
them  all,  the  strongest  soap-leys,  could  only  fetch 
out  a  slight  green  tincture  from  a  gall-stone,  but 


History  and  Cure  of  Diseases,     S07 

neither  seemed  to  lessen  its  bulk,  nor  to  alter  its 
shape,  in  several  months ;  and  there  is  very  little 
likelihood  of  their  being  able  to  do  more  in  the 
body  than  out  of  it.  Gall-stones  were  likewise 
infused  in  every  one  of  the  acid  spirits,  without 
being  dissolved  in  any. 

But  if  we  had  ever  such  powerful  solvents  of 
gall-stones,  it  might  be  doubted  whether  they 
could  do  any  service  in  the  obstructions  which 
these  occasion ;  for  whilst  they  remain  in  the 
ducts,  or  cyst,  the  solvents  cannot  reach  them ; 
and  when  they  are  come  out  into  the  intestines, 
they  want  no  medicines,  but  will  of  course  be 
voided  by  stool. 

It  would  be  very  desirable  to  find  out  a  reme- 
dy, which  would  medicate  the  bile,  so  as  to  make 
it  unapt  to  coagulate,  or  enable  it  to  resolve  the 
concretions  already  formed  ;  and  such  there  may 
be  found  hereafter;  but  though  this  has  been  pre- 
tended of  several,  I  have  no  reason  to  think  it 
true  of  any  ;  and  as  we  do  not  yet  know  any 
which  may  be  safely  taken,  which  can  dissolve 
gall-stones,  it  is  not  likely  that  we  know  any 
thing  which  will  make  the  bile  dissolve  them. 

I  attended  a  person,  who  for  a  stone  in  the 
bladder  of  urine  had  been  in  a  course  of  swallow- 
ing an  ounce  of  soap  every  day  for  seven  years. 
His  distemper  and  advanced  age  having  made  him 
retire  from  all  the  business  of  life,  and  he  being 
naturally  constant  in  what  he  undertook,  I  ima- 

fine  there  could   be  very  few  days,  and  1  do  not 
now  that  there  were  any,  on  which  this  medi- 


SOS  Commentaries  on  the 

cine  was  omitted.  His  body  was  opened  after 
his  death,  and,  notwithstanding  such  an  extraor- 
dinary quantity  of  soap  had  been  taken,  a  great 
number  of  stones  were  found  in  the  gall-bladder, 
which  shewed  no  sign  of  having  been  acted  upon 
by  any  solvent. 

The  only  use  of  soap  and  alkaline  salts  in  a 
jaundice,  as  far  as  we  can  reason  upon  their 
probable  virtues,  is,  to  make  amends  for  the  defi- 
ciency of  the  bile,  which  they  resemble,  in  digest- 
ing the  food,  and  cleansing  the  bowels.  But  too 
much  stress  must  not  be  laid  upon  this  reasoning; 
for  I  have  known  large  quantities  of  an  acid,  such 
as  lemon-juice,  taken  by  some  icteric  patients, 
with  so  much  apparent  benefit,  as  to  have  gained 
the  credit  of  the  cure. 

A  very  judicious  physician  assured  me,  that  he 
had  seen  extremly  good  effects  in  an  inveterate 
jaundice  from  a  scruple  of  volatile  alkaline  salt 
given  three  or  four  times  a  day;  and  he  seemed  to 
be  convinced,  that,  besides  the  virtues  just  men- 
tioned, it  had  some  peculiar  or  specific  ones  in  the 
cure  of  this  disease. 

Specifics  for  it  are  to  be  met  with  in  great 
abundance  among  medical  writers,  many  of  which 
manifestly  owe  their  reputation  to  inconclusive 
reasoning,  or  to  fanciful  criteria  of  the  virtues  of 
medicines  ;  others  are  unsupported  by  well-attest- 
ed experience ;  and  I  have  no  reason,  from  what 
I  have  observed,  to  think  the  testimonies  in  favour 
of  any  of  them  deserve  to  be  examined,  or  men- 
tioned. 


History  and  Cure  of  Diseases,       S09 

The  waters  of  Bath  have  some  credit  of  being 
serviceable  in  a  jaundice.  But  it  must  be  observ- 
ed, that  icteric  patients  generally  recover  where- 
ever  they  are,  and  it  may  be  doubted  v^^hether 
they  recover  the  sooner  for  the  use  of  these  wa- 
ters. However,  there  can  be  no  medical  reason 
for  dissuading  any  one,  in  a  simple  jaundice,  from 
going  to  Bath  ;  because  the  waters  are  perfectly 
safe,  and  the  proper  medicines  may  be  taken 
there,  as  well  as  any  where  else;  while  the  va- 
cancy from  care  in  such  public  places,  together 
with  the  change  of  air,  and  water,  and  objects, 
may  be  of  some  use  to  the  general  health,  and 
thereby  facilitate  the  cure  of  this,  as  they  often 
p  do  of  many  other  chronical  disorders. 

Before  I  conclude,  it  may  be  of  some  use  to 
observe,  that  biliary  concretions  are  probably  one 
jause,  amidst  various  others,  of  that  commonest 
if  all  complaints,  an  uneasiness,  or  pain,  as  it  is 
called,  of  the  stomach.  This  I  have  been  induc- 
ed to  believe,  from  finding  that  in  many  persons  a 
pain  of  the  stomach,  which  had  frequently  afflicted 
them  for  months,  or  years,  has  at  last  been  joined 
by  a  jaundice.  When  therefore  a  pain  of  this 
kind  frequently  returns,  without  any  other  mani- 
fest cause,  especially  if  there  be  at  the  same  time 
a  sensation  of  fulness,  a  thickening  of  the  bile 
may  generally  be  suspected ;  and  gentle  vomits, 
and  a  course  of  purging  waters,  or  any  other  mild 
purgatives,  will  prove  the  most  effectual  cure. 

27 


^10  Commentaries  on  the 

CHAPTER  />]. 

Ileus, 

The  ileus,  or  inflammation  of  the  bowels,  has 
for  its  subject  cliiefly  adults,  and  especially  those 
who  have  ruptures,  or  who  perhaps  from  some 
less  apparent,  but  equally  unnatural  situation  or 
conformation  of  the  bowels,  have  often  been  af- 
flicted with  colicky  pains.  Yet  childhood  is  not 
exempt  froin  this  very  dangerous  disorder:  some 
have  died  of  it  in  their  sixth  or  seventh  year  with 
all  the  usual  symptoms;  and  it  is  not  unlikely, 
that  this  may  make  one  of  the  many  bowel  disor- 
ders which  are  so  fatal  to  children  for  the  first 
three  or  four  years  of  their  lives. 

It  begins  with  a  pain  usually  referred  to  the  sto- 
mach or  the  bowels  :  this  sometimes  comes  on 
suddenly,  and  with  violence ;  or  from  small  be- 
ginnings gradually  increases ;  and  in  rare  cases 
has  even  seemed  to  abate  for  a  few  days,  and  then 
has  returned  never  to  yield  again  to  any  reme- 
dies. The  navel  has  been  complained  of,  and  so 
has  the  back,  as  the  chief  seat  of  the  pain,  even 
in  those  who  have  had  inguinal  ruptures ;  which 
have  undoubtedly  been  often  the  original  cause, 
but,  as  I  suspect,  not  always  the  seat  of  the  in- 
flammation ;  and  in  some  cases  the  colic  may  have 
nothing  to  do  with  a  hernia,  which  the  patient 
chances  to  have,  but  is  wholly  owing  to  some  of 
those  causes,  which  produce  it  in  persons  who 
never  were  ruptured.  Eructation  of  wind,  which 
usually  accompanies  this  illness,  and  likewise  the 


History  and  Cure  of  Diseases,  211 

action  of  coughing,  aggravate  the  pain  to  a  degree 
hardlj  tolerable. 

It  has  happened  in  one  or  two  instances,  that 
the  ileus  has  from  the  very  beginning  occasioned 
restlessness  and  uneasiness  rather  than  pain,  even 
in  those,  after  whose  death  a  portion  of  the  intes- 
tine  has  been   found   sphacelated.     The   pain  in 
those  who  recover,  is  changed  into  soreness,  with 
a  manifest  relief  of  all  the  other  symptoms ;  and 
into  restlessness  in  those  who  die,  all  the  other 
symptoms    at    the    same    time    becoming    worse. 
The  duration  of  the  pain,  before  it  makes  a  fa- 
vourable, or  fatal  change,  is  very  various,  accord- 
ingly perhaps  as  there  may  be  a  small  portion  of 
one,  or  a  large  part  of  several  of  the  intestines  in- 
flamed;  and  according  to  the  greater  or  less  influ- 
ence of  those  causes  which  retard  or  hasten  the 
progress  of  inflammations  towards  a  cure,  or  a 
gangrene  :   so  that  the  distemper   has  destroyed 
the   patient  on  all   days   from   the  second    to  the 
fourteenth.     It   is  obvious,  that  a  violent  injury 
by  a  blow,  or  fall,  or  by  some  corrosive  poison, 
may  excite  such  an  inflammation  of  the  bowels,  as 
will  be  fatal  on  the  first  day,  or  in  a  few  hours. 

The  state  of  the  pulse  is  of  great  importance 
in  ascertaining  the  nature  of  those  symptoms, 
which  the  colic  has  in  common  with  icteric  and 
spasmodic  complaints,  where  the  vomiting  and 
pains  are  sometimes  as  great,  but  without  any 
danger;  for  in  the  ileus  it  almost  always  has  a  fe- 
verish quickness,  but  in  the  others  it  beats  in  the 
natural  maruier  :  and  yet  for  some  cause,  about 
which  lean  form  no  conjecture,  it  happens,  though 


sue  Commentaries  on  the 

very  rarely,  in  this  and  in  other  inflammatory  and 
malignant  cases,  as  has  been  elsewhere  mentioned, 
that  the  pulse  continues  in  a  natural  state,  giving 
not  the  least  notice  of  danger,  or  of  approaching 
death.     I  have  observed   this  thrice  in  the  ileus. 

A  hiccup,  and  an  unquenchable  thirst,  often 
come  on  early  in  the  distemper,  and  tease  the  pa- 
tient through  its  whole  course. 

There  is  such  a  disposition  in  the  stomach  to 
reject  every  thing,  that  it  is  often  difficult,  even  in 
the  beginning  of  this  malady  to  contrive  any  food 
or  medicine  which  can  be  kept.  Afterwards,  be- 
sides what  has  been  taken  down,  there  is  vomited 
up  a  brownish  liquor,  of  which  I  have  heard  many 
patients  and  their  nurses  say,  that  it  affected  their 
senses  like  excrement  ;  and  therefore  I  suppose  it 
to  be  so,  though  it  never  struck  me  as  having  a 
stercoreous  smell.  The  old  medical  writers  like- 
wise call  it  liquid  excrement.  This  has  made  its 
a|)pearance  on  the  first  or  second  day,  but  has  not 
usually  been  observed  sooner  than  the  third  or 
fourth  ;  it  has  been  delayed  till  the  eighth.  Above 
two  quarts  have  been  vomited  up  daily  for  six  or 
seven  xlays,  during  which  the  patient  hardly  took 
any  thing.  It  is  probably  supplied  in  the  same 
manner  as  the  evacuations  in  a  violent  diarrhoea. 
From  this  symptom  it  has  been  concluded,  that,  at 
least  in  some  cases,  the  ileus  arises  not  from  a 
stoppage  or  stricture  in  any  part  of  the  bowels, 
but  from  their  irj verted  motion  ;  which  opinion  is 
confirmed  by  what  I  have  heard  the  patients  and 
their  attendant  sassert,  that  clysters  had  been  vom- 
ited up ;  which  has  happened  even  where  the  mis- 


History  and  Cure  of  Diseases.      SI 3 

chief  has  arisen  from  an  inguinal  rupture,  in  which 
it  has  been  supposed  that  the  intestine  was  stran- 
gled in  the  ring  so  that  nothing  could  pass.  In 
the  instant  of  dying,  an  inundation  of  this  liquid 
has  suddenly  burst  forth  upwards  and  downwards. 
This  sort  of  vomiting,  together  with  a  great  infla- 
tion and  tension  of  the  belly,  are  symptoms  of  the 
utmost  danger  ;  yet  some  are  said  to  have  recov- 
ered after  these  appearances  ;  but  instances  of 
this  are,  I  beheve,  extremely  rare. 

When  the  pain  goes  off  wifliout  the  patient's 
being  relieved  in  other  respects,  a  restlessness  and 
anxiety  either  come  on,  or  are  increased  to  a  most 
distressing  degree.  Notwithstanding  the  inquie- 
tude, and  want  of  sleep,  and  the  great  violence 
which  must  be  done  to  the  powers  of  life  by  (his 
very  formidable  disease,  yet  it  hardly  ever  hap- 
pens that  the  patient  is  delirious. 

The  peculiar  and  distinguishing  symptom,  which 
characterises  the  Inflammatory  colic  in  the  very 
beginning,  is  a  costiveness  ;  which  it  is  always 
extremely  difficult,  and  too  often  impossible  to 
conquer.  As  soon  as  a  discharge  downwards  can 
be  procured  in  a  copious  manner,  the  patient  per- 
ceives a  quick  abatement  of  all  his  misery,  and  it 
soon  restored  to  health.  But  it  is  not  from  one 
or  two  small  evacuations,  that  we  can  entertain 
much  hope  of  the  distemper's  beginning  to  give 
way.  This  has  happened  on  the  first  or  second 
day  from  the  excrement  which  was  lodged  in  or 
near  the  rectum,  far  below  the  seat  of j  the  mis- 
chief. And  later  in  the  distemper,  a  very  small 
portion  of  that  liquid  matter,  with  which  the  bow- 


5314  Commentaries  on  the 

els  are  deluged,  has  seemed  to  have  been  forced 
downwards,  while  the  disease  was  every  hour 
growing  worse.  Such  inefficacious  evacuations 
have  been  observed  more  than  once  or  twice  in 
the  course  of  this  illness,  without  saving  the  pa- 
tient's life  :  and  two  or  three  of  them  have  come 
away  not  many  hours  before  a  coldness  of  the  ex- 
tremities came  on,  and  was  soon  followed  by  death. 

Upon  dissection,  there  have  beeh  found  in 
some  bodies,  strictures,  subsisting  after  death  so 
strongly,  that  when  the  gut  was  cut  in  two,  the 
cavity  seemed  entirely  obliterated.  In  others 
there  have  been  various  portions  of  the  intestines 
discoloured  and  sphacelated,  but  without  any 
stricture  or  obstruction  throughout  their  whole 
length.  In  an  inguinal  rupture,  the  intestine  sur- 
rounded by  the  ring,  was  so  far  from  being 
strangled,  that  two  fingers  could  pass  between 
them  ;  and  the  gut  in  that  part  had  been  less  in- 
flamed than  w^hat  had  fallen  into  the  scrotum, 
which  was  black  and  mortified.  Death  perhaps 
might  have  made  some  alteration  in  these  appear- 
ances. A  person  has  died  with  all  the  usual 
symptoms  of  the  ileus,  where  the  only  part  affect- 
ed was  half  the  circumference  of  the  outward 
membrane  of  the  colon,  which  for  the  length  of 
five  inches  was  black.  A  very  small  portion  of 
the  gut,  and  empty  of  all  contents,  so  that  it  was 
imperceptible  externally,  had  fallen  into  the  groin, 
and  was  mortified,  in  one,  who  died  on  the  four- 
teenth day  of  the  disease. 

This  account  of  the  ileus  shows  that  all  heating 
things  must  be  avoided,  which  have  been  too  of- 


History  and  Cure  of  Diseases.     S15 

ten  given  ;  and  that  its  cure  must  depend  upon 
the  success  of  those  means  which  abate  inflamma- 
tions, and  procure  stools.  The  first  of  these  pur- 
poses is  best  answered  by  bleeding,  as  often  as 
it  is  judged  that  the  symptoms  require,  and  the 
strength  of  the  patient  will  bear.  Warm  bathing 
will  greatly  assist  the  good  effects  of  the  bleed- 
ing, and  cannot  be  repeated  too  often  :  it  very 
rarely  fails  of  giving  a  temporary  relief,  by  pro- 
curing a  perfect  respite  from  the  pains,  as  long  as 
the  patient  continues  in  the  bath.  Fomentations, 
and  bladders  half  full  of  warm  water  applied  to 
the  belly,  are  weaker  remedies  of  the  same  kind 
with  the  bath.  The  application  of  a  blister  to 
the  same  part  has  been  attended  with  apparent 
benefit,  and  acts  perhaps  both  by  moderating  the 
inflammation,  as  when  put  upon  the  side  in  pleu- 
risies, and  also  by  correcting  those  spasms  which 
obstruct,  or  invert,  the  natural  motion  of  the  in- 
testines. 

All  these  helps  are  greatly  serviceable  in  dis- 
posing the  bowels  to  yield  to  the  power  of  cathar- 
tic medicines  ;  by  the  failure  or  success  of  which 
the  life  or  death  of  the  patient  must  at  last  be  de- 
termined. It  is  a  misfortune  that  the  taste  of 
purging  drugs  is  generally  disagreeable  and  nau- 
seous ;  especially  as  a  loathing  of  every  thing,  and 
a  Vomiting,  are  symptoms  which  distress  these 
patients  in  the  very  beginning.  Hence  arises  a 
very  great  difficulty  of  contriving  any  purgative, 
which  can  be  taken  and  kept.  However,  they 
who  can  swallow  pills,  have  very  readily  taken 
five  grains  of  cathartic  extract  made  into  a  pill, 
and  repealed  it  every  half  hour  until  it  had  the 


S16  Commentaries  on  the 

proper  effect.  One  or  two  spoonfuls  of  a  strong 
solution  of  cathartic  salt  in  weak  broth,  or  in  pep- 
permint water,  has  often  been  retained,  when  no- 
thing else  would  stay  upon  the  stomach.  The 
infusion  of  senna,  given  in  the  same  manner,  has 
sometimes  been  borne ;  and  so  has  even  the  cas- 
tor oil.  In  a  very  {ew  instances  I  have  known 
this  oil  rubbed  for  a  considerable  time  over  the 
belly,  where  the  patient  has  thought  that  this 
mode  of  using  it  contributed  not  a  little  to  the 
bringing  on  a  proper  and  plentiful  evacuation, 
and  sometimes  with  great  pain  and  griping.  Ca- 
lomel, and  other  mercurial  preparations,  have 
been  judged  to  quicken  the  virtue  ol  purgative 
medicines,  and  to  render  their  operation  far  more 
certain.  This  power  of  meri  ury  has  not  been  sa- 
tisfactorily confirmed  to  me  by  experience ;  per- 
haps because  I  have  not  used  it  often  enough,  or 
not  in  cases  which  admitted  any  relief  Clysters 
seem  to  do  very  little  good,  except  those  prepar- 
ed from  tobacco ;  the  smoke  of  which  is  commo- 
diously  thrown  up  this  way  by  such  an  instrument, 
as  is  now  commonly  used  by  gardeners  to  fumi- 
gate trees  in  order  to  (tee  them  from  insects.*  (t 
is  not  unlike  the  wooden  one  described  in  Heis- 
ter's  Surgery  ;  but  it  should  be  made  of  brass, 
and,  instead  of  a  pipe  at  the  top,  to  which  in  Heis- 
ter's  the  mouth  is  to  be  applied,  there  should  be 
a  conical  brass  tube,  the  top  of  which  should  be 
so  small  as  to  enter  an  inch  at  least  into  any  com- 
mon chamber  bellows.  This  is  much  more  com- 
modious than  when  the  tube  is  made  to  screw  on 

*  Among  the  remedies  for  the  ileus,  Hippocrates  mentions  inflate 
ing  the  intestines  :  $yo-*v  ^et^MuriMv  mtvah  km  <puff*v  ss  rw  *w?i<»»y.— 
Tlt^i  Nwo-av,  XV.  E. 


History  and  Cure  of  Biseases.        217 

to  the  pipe  of  a  pair  of  bellows  made  on  purpose 
for  it ;  for  then  the  bellows  must  always  be  carri- 
ed with  it ;  whereas  any  common  pair  may  be  us- 
ed witfi  the  conical  tube.  The  tobacco  is  very 
conveniently  lighted  by  a  piece  of  touch-p)aper. 
The  smoke  of  tobacco  thus  conveyed  into  the  rec- 
tum acts  very  powerfully  in  controlling  the  irre- 
gtilai  motion  of  the  intestines,  and  in  forcing  them 
strongly  to  empty  their  contents  in  the  natural 
manner.  Such  an  enema  has  sometimes  succeed- 
ed the  first  time  of  using  it,  and  sometimes  not  un- 
til it  had  been  repeated  every  four  hours  for  a 
whole  day  :  and  in  too  many  cases  it  has  totally 
failed  of  doing  any  good.  Possibly  some  sorts  of 
toba«:co  may  possess  this  virtue  in  a  stronger  de- 
gree than  others,  which  by  future  experience  may 
be  ascertained.  Where  the  proper  instrument 
for  giving  the  smoke  cannot  be  had,  there  an  in- 
fusion of  tobacco  may  be  used,  made  of  twelve 
ounces  of  boiling  water,  poured  upon  half  a  quar- 
ter of  an  ounce  of  tobacco.  This  infusion  strain- 
ed has  been  borne  without  occasioning  vomiting 
or  sickness,  but  it  has  seemed  to  aifect  the  head 
with  giddiness  more  than  the  smoke. 

A  pound  of  quicksilver  has  been  taken  in  order 
force  a  passage  by  its  weight,  and  has  probably 
>een  preferred  to  an  equal  weight  of  water,  or 
►roth,  as  being  less  likely  to  be  vomited  up,  ei- 
\er  by  lying  in  so  small  a  compass,  or  by  some 
)ecific  anti-emetic  virtue  of  the  quicksilver.     But 
the  few   instances,   in  which  1  have  known  it 
iven,  it  has  by  no  means  succeeded  ;  and  it  does 
lot  seem  likely  that  it  ever  should  :  for  the  ob- 
struction may  be  in  an  ascending  part  of  the  in- 
28 


k 


S18  Commentaries  on  the 

testine :  and  thouj^h  this  weight  could  be  applied 
in  the  most  advantageous  manner,  yet  the  force 
which  constringes  the  intestines,  or  inverts  their 
motion,  is  in  all  probability  far  superiour  to  the 
power  of  gravity  alone  in  any  quantity  of  liquid, 
or  solid,  that  could  be  taken  down. 

Against  the  use  of  opium  in  this  malady  it  has 
been  urged,  that  narcotics  deaden  the  irritability 
of  the  bowels,  and  defeat  the  operation  of  cathar- 
tics, on  the  effect  of  which  the  cure  of  the  patient 
depends.  In  favour  of  opiates  it  may  be  consider- 
ed, that  they  check  the  vomiting,  and  enable  the 
stomach  to  retain  such  a  quantity  of  purging 
drugs,  as  may  far  overbalance  the  binding  quality 
of  the  anodyne.  Besides,  it  is  well  known  that 
opium  has  a  sovereign  virtue  of  controlling 
spasms,  and  all  irrregular  convulsive  motions  of 
muscular  fibres.  Lastly,  the  want  of  sleep,  with 
which  these  patients  are  worn  down,  and  the  in- 
cessant restlessness  with  which  they  are  fatigued, 
call  aloud  for  the  assistance  of  this  medicine. 
Upon  this  view  of  the  reasons  on  both  sides,  the 
probability  of  advantage  from  anodynes  has  deter- 
mined me  to  recommend  them,  and  experience 
has  strongly  confirmed  this  judgment.  Under  the 
protection  of  an  opiate,  I  have  successfully  given 
more,  and  stronger  purges,  than  would  have  stay- 
ed without  its  help ;  the  patient's  strength  has 
been  kept  up  by  some  refreshing  sleeps ;  and  even 
in  hopeless  cases,  in  which  the  dying  person  is 
harassed  by  unspeakable  inquietude,  he  may  be 
hilled  into  some  composure,  and  without  dying  at 
all  sooner,  may  be  enabled  to  die  more  easily. 
Lord  Veruiam  blames  physicians  for  not  making 


^B  the  euthanasia  a  part  of  their  studies :  and  surely 
though  the  recovery  of  the  patient  be  the  grand 
aim  of  their  profession,  yet  where  that  cannot  be 
obtained,  they  should  try  to  disarm  death  of  some 
of  its  terrours,  and  if  they  cannot  make  him  quit 
his  prey,  and  the  hfe  must  be  Jost,  they  may  still 
prevail  to  have  it  taken  away  in  the  most  merciful 
manner. 

.# 
Where  the  inflammatory  colic  is  joined  with  a 
rupture,  it  is  right  to  reduce  the  rupture,  if  it  can 
be  easily  done ;  but  it  is  doubtful  whether  much 
pains  should  be  taken  about  it,  for  it  is  unceKain 
that  the  rupture  is  the  seat,  or  the  cause  of  the  in- 
flammation. An  ileus  is  often  seen  without  a 
rupture  ;  and  a  rupture  without  an  ileus  ;  and  con- 
sequently the  symptoms  may  go  off,  though  the 
rupture  continue ;  just  as,  without  this,  they  often 
come  on  :  and  the  symptoms  have  continued,  and 
ended  in  death,  notwithstanding  the  reduction  of 
the  rupture.  Be  the  case  as  it  will,  all  violent 
means  to  reduce  the  hernia  will  be  more  likely 
to  aggravate  than  to  relieve  the  disease.  We 
know  that  a  hernia  does  not  necessarily  hinder 
the  operation  of  purges  ;  and  if  their  effect  be  but 
copious,  the  patient  may  be  secure  of  his  reco- 
very. 

The  operation  of  dilating  the  ring  with  a  knife, 
and  by  that  means  freeing  the  gut  from  the  stric- 
ture by  which  it  is  supposed  to  be  strangled,  is, 
as  far  as  I  have  observed,  very  rarely,  if  ever,  ad- 
visable, as  well  upon  other  accounts,  as  for  all 
the  reasons  which  have  been  just  mentioned. 
No  one,  who  has  ever  seen  it  performed,  can  help 


:?30  Commentaries  on  the 

having  a  dread  of  directing  such  a  hazardous  ope- 
ration too  soon,  or  such  a  painful  one  too  late  : 
and  we  are,  I  think,  greatly  at  a  loss  for  any  rules 
of  judging  in  what  case,  and  at  what  precise  time 
of  the  ilhiess,  this  operation  may  be  successful, 
and  nothing  else. 


CHAPTER  52. 

Inflaiio  et  Ructus. 

Flatulence  is  not  an  original  distemper,  but 
attends  upon  most  disorders  of  the  stomach  and 
bowels.  It  is  very  commonly  one  of  the  numerous 
evils  belonging  to  hysteric  and  hypochondriac  pa- 
tients ;  and  is  sometimes  the  forerunner  of  an  epi- 
leptic fit.  Great  complaints  of  wlndiness  are  in 
different  persons  accompanied  with  indigestion, 
sickness,  vomiting,  some  difficulty  in  swallowing, 
excessive  uneasiness,  almost  to  choking  and  con- 
vulsions, languors,  a  sense  of  fainting,  a  loss  of 
voice,  giddiness,  and  palpitations  of  the  heart. 

This  complaint  is  commonly  rendered  worse, 
but  not  always,  by  costiveness  ;  and  though  some- 
times it  be  relieved^  yet  it  is  oftener  increased  af- 
ter eating.  Bath  is  no  certain  cure  for  flatulence; 
nor  indeed  can  it  be  expected,  that  the  same 
means  should  always  remove  a  disorder,  whi(  h  is 
a  symptom  of  various  diseases.  If  the  original 
disease  be  known,  the  remedies  must  be  applied 
there;  but  if  flatulence  be  the  only  complaint,  the 
best  medicine  will  be  some  warm  and  gentle  ape- 


History  and  Cure  of  Biseases.       S8i 

rient.  Tlie  following  has  been  signally  useful, 
taken  every  night  in  powder,  or  in  pills  :  lialf  a 
scruple  of  powder  of  chaaiomile  flowers,  three 
grains  of  long  pepper,  and  one  of  aloes. 

Fits  of  eructation  hrive  returned  every  day  both 
periodically  and  at  uncertain  hours.  They  have 
been  joined  with  giddiness,  heartburn,  and  hiccup, 
and  have  risen  almost  to  a  degree  of  convulsions. 
Wine  and  sweet  things  have  proved  hurtful. 
Acids  have  been  beneficial.  Vomits  and  purges 
have  been  useless. 


CHAPTER  63. 

Insania. 

Great  anxiety  of  mind,  whatever  may  have 
been  its  origin,  is  a  principal  cause  of  insanity, 
that  is,  a  disordered  understanding,  with  a  quiet 
pulse  and  without  any  acute  illness.  It  has  been 
the  consequence  of  some  diseases,  particularly  of 
worms,  and  epileptic  fits,  and  of  many  affections 
of  the  head,  as  dropsies  of  the  ventricles  of  the 
brain,  and  scirrhous  tumours,  and  also  of  blows. 
Sleeplessness,  and  disagreeable  sensations  of  the 
bowels  sometimes  also  rising  up  to  the  head,  of- 
ten precede  perhaps  rather  than  cause  lunacy. 
Women  seem  much  more  liable  to  this  misfortune 
than  men,  and  particularly  at  the  time  of  their  ly- 
ing in.      • 

It  is  one  of  those  distempers,  which  hardly  ever 
appear  before  the  age  of  puberty.     I  have  never 


SSS  Commentaries  on  the 

seen  it  earlier  than  in  the  sixteenth  jear.  An  he- 
reditary cause  of  madness  has  lain  dormant  even 
till  old  age,  and  has  made  its  first  appearance  af- 
ter sixty. 

It  is  an  inveterate  opinion,  which  my  experience 
has  uniformly  contradicted,  that  madness  is  influ- 
enced by  the  moon. 

The  gout  is  supposed  to  absorb  other  distem- 
pers, and  to  turn  them  so  perfectly  into  its  own 
nature,  that  no  traces  shall  appear  of  any  other 
malady  beside  the  gout.  I  will  not  Jiinswer  for 
the  truth  of  this  observation  ;  but  I  make  no  doubt 
of  my  having  observed  some  power  of  this  kind  in 
madness ;  upon  the  access  of  which  I  remarked  an 
extraordinary  and  immediate  recovery  of  strength 
and  health  in  one,  who  was  languishing  with  ex- 
treme weakness  consequent  upon  a  fever.  In  an- 
other, who  had  every  sign  of  a  pulmonary  con- 
sumption advancing  fast  to  its  last  stage,  madness 
came  on,  and  presently  made  a  cure  of  the  con- 
sumption, pf  which  1  almost  despaired  by  any 
other  means. 

Great  violence  is  probably  done  to  the  brain, 
when  a  man  is  deprived  of  reason,  the  principal 
characteristic  of  his  nature  :  but  the  parts  of  the 
brain  subservient  to  animal  life,  seem  so  distinct 
from  those  which  are  essential  to  the  exercise  of 
reason,  that  insanity  has  in  many  instances  been 
no  hindrance  to  the  enjoyment  of  good  health  in 
all  other  respects  even  to  extreme  old  age. 

Those  who  have  been  cured  of  lunacy,  are  very 
apt  to  have  relapses  ;  and  some  divide  their  whole 


History  and  Cure  of  Diseases.        2S3 

lives  between  madness  and  reason.  Such  as  ne- 
ver return  to  the  use  of  their  senses,  are  alter- 
latelj  under  the  dominion  of  spirits  either  too 
Irooping,  or  too  elevated  ;  in  each  of  which  states 
it  is  nol  uncommon  to  have  them  pass  several 
months  together  :  they  appear  most  reasonable  in 
the  melancholy  ^t  An  old  madness  in  some  be- 
comes stupidity,  and  idiotcy.  Mad  persons  seem 
to  have  a  very  imperfect  manner  of  measuring 
time.  Some,  upon  my  asking  them,  have  told  me 
that  they  believed  they  had  passed  two  months  in 
a  state  of  confinement,  in  which  they  had  in  reali- 
ty been  above  twenty  years. 

In  the  beginning  of  madness,  which  the  patients 
are  too  apt  to  increase  by  drinking  strong  liquors 
to  excess,  and  by  many  unnecessary  hurries  into 
which  they  put  themselves,  quiet  and  confinement 
(not  under  the  care  of  their  own  servants,  but  ra- 
ther of  strangers,  of  whom  they  may  stand  in 
some  awe)  will  often  restore  them  to  their  senses 
"without  the  help  of  medicines.  But  where  they 
are  at  all  disposed  to  be  costive,  or  have  heated 
themselves  by  their  imprudent  manner  of  living, 
they  have  been  greatly  assisted  in  their  recovery 
by  the  use  of  some  purging  physic.  Opium  has 
also  been  sometimes  useful  in  composing  their 
minds  by  procuring  them  sleep.  Beside  these, 
and  what  may  be  further  necessary  to  put  their 
general  health  in  good  order,  and  to  keep  it  so,  I 
have  observed  nothing  which  has  been  of  any  ser- 
vice in  removing  this  great  affliction. 


SS4  Commentaries  on  the 

CHAPTER  54. 

Intcstinorum  Dolores. 

Pains  of  the  bowels  arise  from  a  great  variety 
of  causes  which  we  know,  and  probably  from  se- 
veral others  which  we  do  not  suspect,  and  care 
must  be  taken  to  refer  them,  as  far  as  we  are  able, 
to  their  true  origin  ;  for  according  to  this,  very 
different  treatments  may  be  required. 

Diseases  of  the  ovaries,  womb,  bladder,  kid- 
neys, spleen,  pancreas,  liver,  and  omentum,  are 
often  confounded  under  the  general  name  of  pains 
in  the  bowels.  A  stone  in  tne  gall-bladder  I  have 
great  reason  to  believe  is  a  much  more  common 
cause  of  such  complaints  than  has  been  generally 
supposed  ;  for  many  of  them,  after  returning  fre- 
quently for  above  twenty  years,  have  shewn  their 
true  nature  at  last  by  being  joined  with  signs  of 
the  jaundice.  Scirrhous  tumours  and  ulcers  in 
every  part  of  the  abdomen,  worms,  especially  in 
children,  and  ruptures  in  adults,  the  colica  Picto- 
num,  ileus,  and  strictures  in  various  parts  of  the 
intestines,  with  other  mal-conformations,  must 
be  kept  in  mind,  as  the  possible  maladies  of  these 
patients.  The  affections  of  the  womb,  or  of  any 
parts  belonging  to  it,  may  be  probably  conjectur- 
ed from  the  fixed  seat  of  the  pain,  and  from  its 
relation  to  the  menstrual  discharge,  to  child-bear- 
ing, or  miscarriages.  Those  of  the  kidneys  and 
bladder  will  shew  themselves  not  only  by  their 
situation,  but  also  by  the  preternatural  appearan- 
ces of  the  urine,  or  by  the  frequency  and  pain  of 


Bistory  and  Cure  of  Diseases.       §26 

making  water :  and  a  further  sign  of  the  affections 
of  the  womb,  kidneys,  or  bladder,  is  afforded  by 
the  small  concern  which  they  have  with  the  stools* 
The  ileus  or  inflammation  of  the  intestines,  is  too 
acute,  and  too  strongly  marked,  to  be  easily  mista- 
ken. Ruptures  cannot  but  be  found  out,  unless  the 
patient  use  art  to  conceal  them.  Where  worms  do 
not  shew  themselves  in  the  stools,  a  disposition  to 
them  may  still  be  discovered  by  the  state  of  the 
[faeces,  which  requires  the  same  treatment.  The 
colica  Pictonum,  if  the  person  be  not  known  to 
have  been  hurt  by  lead,  is  many  times  not  clearly 
ascertained,  until  the  limbs  begin  to  be  paralytic. 
Ulcers  and  scirrhous  glands  in  the  intestines  will 
greatly  derange  their  functions,  and  the  discharge 
from  the  ulcers  may  appear  in  the  stools ;  and  ei- 
ither  here,  or  in  any  other  of  the  abdominal  visce- 
[ra,  they  are  almost  always  accompanied  with  loss 
[of  appetite,  of  flesh,  and  of  strength,  with  a  quick 
pulse,  and  swelled  legs.  But  if  we  were  ever  so 
sure  of  the  presence  of  these  sores,  and  tumours, 
or  of  adhesions,  and  strictures  of  the  intestines,  or 
.other  mal-conformations,  they  would  only  direct 
us  to  do  nothing  further,  than  mitigating  the  ur- 
gent symptoms. 

Beside  all  these,  and  the  periodical  pains  before 
mentioned,  the  stomach  and  intestines  are  liable 
to  uneasiness  and  pain,  arising  from  a  constitution- 
al weakness  and  languidness  in  performing  their 
functions  of  digestion,  assimilation,  and  expulsion  ; 
or  from  an  accidental  one  owing  to  the  improper 
quantity,  or  quality  of  the  food,  to  the  injudicious 
healing  of  cutaneous  ails,  or  to  disorders  of  the 
head,  or  limbs,  which  by  some  hitherto  undisco- 

29 


226  Commentaries  on  the 

vered  power  are  transferable,  as  experience  teach- 
es us,  into  the  bowels,  and  from  them  back  again 
to  their  former  seat.  Such  a  faihng  of  the  natu- 
ral vigour  of  these  parts  will  be  productive  of 
sickness,  vomiting,  diarrhoea,  tenesmus,  flatulence, 
a  sense  of  fullness,  a  tension  of  the  bellj,  borbo- 
rygmi,  pains  like  the  cramp,  a  difficulty  in  making 
water,  and  such  a  strong  acid,  as  will  almost  ex- 
coriate the  parts  through  which  it  passes  in  going 
upwards  or  downwards. 

A  sudd.en  attack  of  pains  in  the  bowels  should 
in  no  case  be  treated,  as  it  too  commonly  is,  with 
spirituous  liquors :  when  they  proceed  from  the 
improper  quantity,  or  quality  of  food,  or  fruit,  a 
vomit,  or  a  purge,  according  to  what  nature  points 
out,  should  be  immediately  taken  ;  after  either  of 
these  has  had  its  proper  effect,  if  the  pains  or 
purging  require  it,  they  may  be  checked  with  an 
opiate  :  the  consequent  weakness  of  the  bowels 
may  sometimes  require  bitters  and  aromatics  to 
be  taken  morning  and  evening  for  a  few  days. 
Gouty  pains  suddenly  transferred  to  the  bowels 
are  best  relieved  by  such  a  warm  opiate  as  the 
confectio  opiata,  the  dose  and  repetition  of  which 
can  only  be  deterniined  by  the  exigency  of  the 
case.  The  less  dangerous  and  less  acute  uneasi- 
ness, consequent  upon  healing  old  sores,  and  upon 
repelling  slight  pains  of  the  limbs  or  cutaneous 
ails,  will  be  sufficiently  provided  for  by  a  course 
of  aromatics  and  bitters,  taking  care  at  the  same 
time  that  the  body  be  not  costive,  which  is  a  cau- 
tion necessary  in  every  disorder  of  the  bowels. 

A  constitutional  weakness  will  often  be  strength- 
ened, and  a  return  of  the  attendant  pains  prevent- 


History  and  Cure  of  JDiseases.      227 

by  drinking  Bath  water,  and  by  the  use  of  a 
lannel  waistcoat  over  the  shirt ;  for  cold  is  detri- 
lental.     Such  patients  may  take  with  great  ad- 
vantage  a   bitter  and  aromatic  powder  once  or 
twice  a  day  for  many  months,  to  each  of  which 
»owders,  if  the  persons  are  teazed  with  purging, 
lay  be  added  two  or  three  drops  of  tincture  of 
ipiura ;  but  if  they  are  hurt  by  the  other  extreme, 
they  may  take  three  or  four  grains  of  rhubarb 
every  day  mixed  with  one  of  the  powders,  or  ten 
grains  twice  a  week.     In  shghter  cases,  an  acci- 
dental increase  of  pain,  if  it   be  not  considerable 
enough  for  the  use  of  opium,  may  be  relieved  by 
a  few  spoonfuls  of  simple  peppermint-water,  or  by 
applying  warm  cloths,  or  a  bladder  of  warm  wa- 
ter to  the  abdomen.     The  affections  of  the  sto- 
mach are  so  much  of  the  same  nature  with  those 
of  the  intestines,   and  often  so  undistinguishable 
from  them,  that  most  of  what  is  said  under  each 
of  these  articles  is  equally  applicable  to  both  of 
them. 


CHAPTER    55. 

Ischuria. 

A  DIFFICULTY  of  making  water  seems  born  with 
some  persons,  who  have  been  troubled  with  it 
from  their  childhood  without  any  ground  to  sus- 
pect either  a  venereal,  or  a  calculous  cause. 

The  weight  of  the  pregnant  uterus  has  often 
obstructed  the  passage  of  the  urine,  for  which  a 


SS8  Commenturies  on  the 

change  of  posture  will  sometimes  be  a  remedy, 
and  some  women  are  so  distressed  with  it,  that 
while  they  are  in  the  last  months  they  can  never 
part  with  any  water  without  the  help  of  the  ca- 
theter. A  similar  effect  may  arise  from  the  stone 
in  the  bladder.  Venereal  disorders  will  disease 
the  urethra ;  and  sometimes,  as  I  suspect,  this 
mischief  has  been  done  by  the  injections,  which 
have  been  used  for  their  cure  :  these  may  be  re- 
lieved, but  I  have  seldom  known  them  to  be  cur- 
ed, by  a  long  continued  use  of  a  bougie.  1  have 
been  witness  to  a  fatal  suppression  of  urine  from 
this  cause. 

A  woman,  after  a  difficult  labour,  had  a  reten- 
tion of  urine  for  nearly  three  days  :  the  catheter 
was  then  introduced,  and  brought  off  above  five 
pints  of  urine. 

In  a  young  woman,  the  taking  of  an  emetic 
was  three  times  followed  by  a  suppression  of 
urine, 

All  these  obstructions  of  the  urinary  passages 
happen  without  any  fault  in  the  kidneys  ;  but  the 
most  dangerous  ischuria  is  that,  in  which  the  kid- 
neys secrete  no  urine  from  the  blood.  Ir^  one  pa- 
tient, stones  in  the  kidneys  were  probabi}  the 
cause  of  an  incurable  retention  of  tiie  urine;  but 
I  have  had  no  reason  to  think  this  of  any  other, 
whom  I  have  attended  ;  and  it  is  not  like})  to  hap- 
pen often,  that  the  kidneys  should  be  destroyed 
by  calculous  matter,  and  both  of  them  be  made 
wholly  useless,  or  that  both  the  ureters  should 
happen  to  be  plugged  up  at  the  same  time,  so  as 


History  and  Cure  of  Diseases.  229 

to  let  no  water  pass.  Whatevep  probability  there 
may  be,  that  the  bladder  is  empty,  and  that  the 
disease  is  in  the  kidneys,  it  will  still  be  advisable 
in  every  suppression  to  make  the  matter  certain 
by  the  introduction  of  a  catheter. 

Extreme  restlessness,  and  sometimes  a  lethar- 
gic stupor,  accompanies  an  ischuria,  together  with 
vomiting,  hiccup,  fever,  and  pains  in  the  loins. 
One  of  these  patients  complained  of  a  strangury  ; 
but  I  have  not  remarked  that  others  have  shewn 
any  desire  of  making  water.  One  man  also  com- 
plained of  an  urinous  taste  in  his  mouth,  in  whom 
I  had  reason  to  suspect,  that  urine  was  secreted 
in  the  kidneys,  but  could  not  pass  off. 

A  total  suppression  has  lasted  seven  days,  and 
yet  the  patient  has  recovered.  It  has  been  fatal 
so  early  as  on  the  fourth  day.  But  in  general 
those  patients,  who  could  not  be  cured,  have 
sunk  under  their  malady  on  the  sixth  or  seventh 
day. 

A  draft  with  spirit  of  turpentine  from  ten  drops 
to  thirty  has  been  given  every  five  hours ;  a  clys- 
ter with  half  an  ounce  of  spirit  of  turpentine 
has  been  injected  twice  a  day ;  half  a  grain  of 
cantharides  has  been  taken  every  four  hours;  and 
clysters  have  been  employed  with  half  an  ounce 
of  diuretic  salt ;  and  warm  bathing  as  often,  and 
as  long  as  the  patients  could  bear  it;  and  with  all 
these  the  disteuiper  has  ended  happily.  But  on 
the  other  hand  all  these  remedies  have  in  some 
case  been  tried  without  success. 


330  Commentaries  on  the 

CHAPTER  56. 

Lingum  et  Oris  Dolor, 

Cancers  of  the  tongue  and  mouth  begin  with 
a  small  hard  lump,  and  sometimes  with  a  little 
sore ;  both  of  which  are  attended  with  pricking 
pains,  and  they  spread  in  the  same  manner  with 
cancerous  sores  in  other  parts.  This  is  so  great 
ah  evil,  that  the  slightest  suspicion  of  it  occasions 
very  great  uneasiness.  It  may  prevent  some 
groundless  alarms  to  be  assured,  that  I  have 
known  a  burning  pain  of  the  mouth  and  tongue 
continue  in  several  persons  for  many  months  with- 
out any  ill  consequences.  A  bitter,  acid,  putrid, 
and  brassy  taste,  which  infects  every  thing  put 
into  the  mouth,  are  usually  the  effects  of  disorder- 
ed stomachs,  or  of  taking  mercurial  medicines. 
A  man,  who  had  not  taken  mercury,  found  every 
thing  which  he  put  into  his  mouth  infected  with 
a  brassy  taste  to  such  a  degree  of  nauseousness, 
that  he  lost  his  appetite,  and  in  two  months  his 
flesh  and  strength  were  greatly  wasted  :  he  took 
test.  ostr.  3ss.  rad.  gent.  gr.  iv.  hier.  pier.  gr.  ss. 
morning  and  evening,  and  soon  began  to  recover 
his  true  taste  and  appetite. 


CHAPTER  57. 
Lipothymia,  or  Fainting. 


A  FAINTING  fit  is  a  momentary  cessation  of  life, 
and  is  an  attendant  upon  worms  in  children,  and 


History  and  Cure  of  Diseases.      331 

upon  those  who  are  paralytic ;  a  slight  epileptic 
fit  appears  in  this  form ;  and  it  is  a  common  be- 
ginning of  a  fit  of  the  hooping-cough  in  adults ; 
it  is  a  symptom  familiar  to  hypochondriac  and  hy- 
steric persons,  and  to  breeding  women,  and  fevers 
sometimes  begin  with  it.  In  general  it  is  more 
common  in  women,  than  in  men. 

It  will  seize  some  persons  without  any  warning, 
and  in  others  it  gives  notice  of  its  approach  by 
pain,  or  a  palpitation,  or  a  sense  of  fulness  in  the 
stomach,  rising  up  thence  to  the  head,  by  a  mist, 
and  flashes  of  light,  spasms,  and  pains  of  the  bow- 
els, giddiness,  cold  sweats,  tremblings,  and  great 
quantities  of  wind  breaking  up  from  the  stomach. 

The  posture  of  kneeling,  or  standing,  too  long 
continued,  especially  with  the  back  to  a  large  fire, 
and  after  exercise,  the  sight,  or  smell  of  disagree- 
able objects,  will  make  many  persons  swoon,  who 
are  otherwise  in  good  health ;  and  the  same  will 
happen  to  some  without  any  apparent  cause. 
When  a  person  is  apt  to  faint  upon  waking  in  a 
morning,  there  is  some  suspicion  of  its  being  a 
slight  degree  of  an  epilepsy. 

One  fit  immediately  succeeds  another  in  some 
persons  for  six  or  seven  times.  Some  recover 
out  of  a  swoon  with  vomiting,  or  purging,  or  with 
great  eructations,  and  complain  of  giddiness,  oth- 
ers feel  themselves  perfectly  well  upon  the  return 
of  their  senses. 

All  kind  of  evacuations  have  been  found  hurt- 
ful to  those  who  are  subject  to  fainting.     Where 


2S2  Commentaries  on  the 

this  disorder  is  habitual,  and  not  complicated  with 
any  other,  I  have  remarked  cold  bathing  to  be 
beneJScial  ;  but  if  it  be  a  symptom  of  another  dis- 
temper, it  will  cease  of  course  when  that  is  cured 
by  its  proper  remedies.  It  seldom  happens  that 
the  swooning  fit  continues  so  long  as  to  require 
much  help  to  recover  a  person  to  life.  Volatile 
salts  applied  to  the  nose  are  generally  sufficient. 
Bleeding  is  utterly  improper.  Rubbing  the  body 
with  hot  cloths,  also  clysters,  might  be  employed, 
if  the  fit  were  to  continue  any  time,  and  all  the 
other  means,  which  are  found  expedient  in  reco- 
vering drowned  persons. 


CHAPTER  58. 

Lumborum  Dolor. 

The  loins  are  the  seat  of  various  pains  derived 
from  many  different  causes,  such  as  the  gout,  rheu- 
matism, a  sudden  cramp  of  the  muscles  lasting 
two  or  three  days,  and  making  all  motion  intole- 
rable, gleets,  fluor  albus,  stones  and  ulcers  of  the 
kidneys,  ulcers  of  the  womb,  pregnancy,  and  the 
approach  of  an  abortion.  I  saw  one  person,  who 
had  complained  of  a  pain  in  this  part  for  fifty 
years,  but  this  was  only  slight,  as  may  readily  be 
imagined.  However  I  attended  another,  in  whom 
a  pain  of  the  loins  had  been  violent  above  seven 
years,  and  motion  increased  it  to  such  a  degree, 
that  during  all  this  time  the  patient  was  incapable 
at  best  of  bearing  a  carriage,  except  for  a  very 
short  time,  and  frequently  could  not  be  moved 


History  and  Cure  of  Diseases.       S33 

from  one  chamber  to  another  without  great  diffi- 
culty ;  and  jet  there  was  no  external  appearance 
of  harm,  nor  any  such  derangement  of  the  animal 
functions,  as  to  point  out  the  cause  ;  neither  was 
the  nature  of  the  complaint  to  be  ascertained  from 
the  effect  of  any  medicines,  which  were  tried  for 
its  relief.  This  woman  at  last  recovered.  The 
remedies  for  this  pain  must  be  the  same,  which 
are  proper  for  the  distemper  of  which  it  is  a 
symptom ;  or  such  as  have  been  mentioned  in 
chapter  29.  under  the  article  of  pain  in  general. 


CHAPTER  59. 

Lumbrici, 

Beside  the  round  worms,  the  ascarides,*  and 
the  two  kinds  of  flat  worms,  there  are  probably 
many  other  small  animals  taken  in  with  our  food, 
capable  of  living,  and  breeding  in  the  human  in- 
testines. 

The  symptoms,  which  have  been  found  joined 
with  worms,  and  which,  upon  their  being  brought 
away,  have  ceased,  are  pains  in  the  head,  giddi- 
ness, sleepiness,  restless  sleep,  and  waking  out  of 
it  in  a  fright  and  with  outcries  ;  convulsions,  fever- 
ishness,  thirst,  paleness,  a  bad  taste  in  the  mouth, 
offensive  breath,  cough,  shortness  of  breath,  itch- 
ing of  the  nose,  pains  of  the  stomach,  sickness, 
loss  of  appetite,   voraciousness,  wasting  of  the 

*  Concerning  the  Ascarides,  see  chapter  10. 
30 


234  Commentaries  on  the 

flesh,  tenusmus,  itching  of  the  fundament  towards 
night,  and  lastly  skins  and  slime  in  the  stools. 

The  tape,  or  flat  worms,  are  the  most  injurious 
to  health  :  the  round  worms  and  ascarides  would 
sometimes  hardly  be  suspected,  if  they  were  not 
discovered  by  the  itching  of  the  fundament,  or  did 
not  appear  among  the  faeces.  I  have  seen  a  tape 
worm  of  the  length  of  four  ells,  which  came  away 
at  once.  Separate  joints  of  it  are  often  voided 
alive.  The  round  worms  will  come  up  alive  into 
the  mouth,  and  I  have  known  them  live  two  or 
three  days  after  they  were  come  out.  In  two  in- 
stances, which  have  occurred  to  me,  there  was 
ground  to  suspect  that  the  jointed  tape  worm  had 
occasioned  epileptic  fits,  madness,  and  idiotcy. 

We  have  the  misfortune  to  have  innumerable 
remedies  for  the  worms ;  this  being  pretty  gene- 
rally a  sure  sign,  that  we  have  not  one,  upon 
which  we  can  with  certainty  depend.  Spirit  of 
turpentine,  oil,  infusions  of  tobacco,  and  mercu- 
rials, which  are  such  deadly  poisons  to  many  small 
animals,  out  of  the  body,  have  been  thrown  up  in 
clysters  without  destroying  the  ascarides ;  they, 
and  probably  the  other  worms,  being  so  defended 
by  the  mucus,  in  which  they  lie,  that  they  are  se- 
cure from  the  action  of  any  noxious  powders,  or 
liquors.  Until  therefore  the  reputation  of  a  spe- 
cific for  worms  be  better  established  in  some  of 
the  many  medicines  which  lay  claim  to  it,  nothing 
better  can  be  done,  than  giving  purging  medicines 
of  any  kind  which  are  best  borne,  and  can  be  re- 
peated without  creating  too  great  a  degree  of 
loathing.     Bitters  either  joined  with  these,  or  in 


History  and  Cure  of  Diseases,  S35 

the  intermediate  times,  may  be  useful,  not  that  I 
have  any  reason  to  beheve  them  hurtful  to  worms, 
but  because  they  will  help  to  restore  the  disor- 
dered stomach  and  bowels  to  their  natural 
strength.  A  pint  of  water  with  as  much  common 
salt  as  could  be  dissolved  in  it,  has  more  than 
once  been  of  singular  use  in  expelling  worms  from 
the  intestines.* 


CHAPTER  60. 

Lymphatica  Glandules, 

Blistering  plasters  are  apt  to  make  the  neigh- 
bouring lymphatic  glands  swell,  but  this  swell- 
ing has  generally  soon  disappeared.  After  a  bhs- 
ter  the  whole  arm  of  one  person  continued  to  be 
swelled  for  a  long  time ;  probably  from  some  ob- 
struction of  the  lymphatic  vessels.  A  blister  ap- 
plied to  the  head  has  in  several  persons  so  ob- 
structed the  course  of  the  lymph,  that  the  whole 
forehead  has  been  enormously  swelled  for  a  day 
or  two.  This  swelling  has  gradually  descended 
to  the  cheeks,  and  chin,  and  neck,  and  then  dis- 
appeared. 

In  an  old  woman,  who  seemed  otherwise  heal- 
thy, and  in  particular  had  no  disease  of  the  breast, 
the  lymphatic  glands  under  the  arms  began  to 
swell,  and  be  obstructed,  in  consequence  of  which 
the  whole  arm  and  hand  swelled  to  an  enormous 
size  without  pitting,  and  after  a  little  while  she 

*  See  Med.  Trans,  vol.  i.  p.  54. 


SS6  Commentaries  on  the 

died.  Likewise  in  a  young  roan  the  face,  and 
head,  and  breast  were  greatlj  swollen  without 
pitting,  the  veins  of  the  breast  were  varicous;  he 
had  pains  in  his  jaws,  was  sleepless,  short  breath- 
ed, could  hardly  bear  to  lie  down,  and  after  a  few 
months  died. 


CHAPTER    61. 

Mammce. 

It  has  been  known  that  milk  has  continued  to 
fill  one  or  both  the  breasts  of  a  woman  for  tour 
months,  for  five,  for  six,  for  seven,  and  even  for 
twelve  months  after  she  had  weaned  her  child. 
In  a  nurse,  who  was  seized  with  the  small-pox, 
the  milk  went  away  just  at  the  height  of  the  dis- 
temper, and  returned  copiously  as  soon  as  that 
was  over. 

A  woman  in  her  fortieth  year  began  to  feel  her 
breasts  swell:  they  were  soon  after  filled  with 
milk,  which  ran  out  for  three  months:  as  soon  as 
this  stopped,  she  became  pregnant :  she  had  no 
child  before  for  six  years. 

It  often  happens  to  lying-in  women,  and  it  may 
happen  to  any  other,  that  the  breast  inflames,  and 
comes  to  suppuration:  the  adipose  membrane 
seems  to  be  the  seat  of  this  inflammation,  the 
glandular  part  being  very  little  concerned  in  it; 
and  it  is  of  no  more  consequence  in  this  part,  than 
such  a  sore  would  be  in  any  other  part  of  the 
body. 


History  and  Cure  of  Diseases.      S37 

A  swelling  of  the  breasts  with  little  or  no  pain, 
except  a  sense  of  tension,  attends  pregnancy, 
and  sometimes  the  regular  menstrual  discharge, 
as  well  as  its  obstructions,  and  various  other  irre- 
gularities. The  breasts  of  women  are  subject 
also  to  pain,  either  with  or  without  a  sweliing, 
which  often  lasts  for  a  long  tfbie,  and  yet  is  of  as 
little  consequence  as  their  swelling,  while  they 
continue  free  from  any  hard  lump.  A  slight  blow 
on  one  of  the  breasts  has  occasioned  a  pain,  which 
lasted  at  least  ten  years  without  the  appearance 
of  its  ever  coming  to  any  further  mischief.  In  a 
great  variety  of  instances,  pain  has  come  on  with- 
out any  external  cause,  and  has  lasted  in  some 
above  twelve  years,  and  then  has  gone  off  spon- 
taneously :  great  care  should  be  taken,  that  this 
paiti  be  not  increased  by  the  pressure  and  tight- 
ness of  the  stays  :  a  gentle  opening  medicine  may 
now  and  then  be  advisable  in  such  a  case.  It  sel- 
dom happens  that  pain  does  not  occasion  a  gene- 
ral fulness  of  the  breast,  but  if  there  be  no  hard- 
ness, which  denotes  a  beginning  scirrhus,  the 
swelling  and  pain  have  often  been  considerable 
without  any  mischief  ensuing. 

A  serous  or  bloody  oozing  from  the  nipple,  has 
been  the  forerunner  of  a  cancer;  and  it  has  like- 
wise often  appeared,  and  the  nipple  has  been  tor 
many  years  drawn  in,  without  making  any  further 
progress  to  that  dreadful  evil.  A  scirrhus,  or 
hard  lump,  though  ever  so  small,  formed  in  the 
breast,  may  justly  cause  some  apprehension  of  ill 
consequences ;  for  I  have  never  known  a  cancer 
come  without  being  preceded  by  this  :  neverthe- 
less I  have  in  many  instances  remarked  that  this 


238  Commentaries  on  the 

has  been  formed  without  being  followed  by  a 
cancer ;  especially  if  there  have  been  no  previous 
pain,  swelling  or  discharge  from  the  nipple.  For 
a  lump  has  frequently  been  felt  by  accident  in  the 
breast,  and  might  perhaps  have  been  there  a  con- 
siderable time  before  it  was  discovered,  the  breast 
being  in  every  oth^V  respect  in  its  natural  state. 
While  a  small  scirrhus  in  the  breast  continues 
quiet,  it  is  best  to  forbear  all  external  applica- 
tions, and  additional  coverings  to  keep  the  breast 
warmer  than  usual ;  nor  can  1  recommend  any 
internal  medicines  ;  an  exact  diet  seems  to  answer 
all  reasonable  purposes.  Nature  will  sometimes 
disperse  a  scirrhous  gland  in  the  breast,  as  1  have 
several  times  observed,  and  particularly  in  one 
woman,  where  the  tumour  seemed  to  tend  to  so 
much  malignity,  that  it  was  thought  advisable  to 
cut  it  out :  some  accidental  circumstances  delayed 
the  operation  for  some  time ;  and  in  the  mean- 
while the  swelling  of  the  breast  became  less,  and 
softer,  and  continued  to  do  so  till  it  totally  vanish- 
ed. These  however  must  be  acknowledged  to 
be  rare  cases ;  but  it  is  by  no  means  unusual  for 
a  scirrhous  swelling  of  the  breasts  neither  to 
grow,  nor  to  be  painful  for  many  years,  especial- 
ly if  it  were  formed,  as  happens  in  a  few  women, 
before  the  age  of  thirty.  The  most  usual,  and 
the  most  dangerous  time  for  the  coming  of  a  tu- 
mour in  the  breast,  is  near,  or  after,  the  fortieth 
year  of  life ;  yet  in  a  woman  of  seventy  it  has  oc- 
casioned neither  pain,  nor  inconvenience  for  seven 
years,  and  seemed  to  have  no  connexion  at  last 
with  the  distemper  of  which  she  died.  I  have 
noted  one  man,  in  whose  breast  a  scirrhous  lump 
had  arisen  exactly  the  same  with  what  is  so  com- 


History  and  Cure  of  Diseases.     239 

mon  in  the  other  sex.      In  another  the  breast  be- 
came cancerous,  and  was  successfully  cut  off. 

As  soon  as  a  hard  tumour  in  this  part  begins  to 
be  uneasy,  and  to  spread  with  pricking  pains,  (in 
which  state  it  has  continued  for  several  years  be- 
fore it  has  broken)  many,  both  external  and  inter- 
nal medicines  have  been  recommended  to  check 
its  progress,  and  to  disperse  it.  I  have  not  seen 
much  reason  to  confide  in  any  of  the  means,  which 
are  supposed  to  have  the  virtue  of  resolving  such 
a  tumour,  after  having  first  soothed  it  to  a  state 
of  indolence ;  though  in  two  or  three  instances  as 
I  have  neted,  the  extract  of  hemlock  has  had  the 
reputation,  and  perhaps  justly,  of  effecting  this. 
But  then  it  has  undeniably  failed  in  so  many  oth- 
ers, that  it  is  in  my  judgment  not  worth  any  bo- 
dy's while  to  waste,  in  making  a  trial  of  it,  any  of 
that  time,  which  is  so  precious  after  the  tumour 
has  once  begun  to  make  advances  towards  ulcera- 
tion. The  insignificant  pain  of  cutting  it  out, 
while  it  is  small,  and  the  prospect  of  its  healing 
readily  on  account  of  the  smallness  of  the  wound, 
and  of  the  health  not  being  yet  much  hurt,  should 
determine  every  one  to  the  operation  at  this  time. 
If  the  breast  be  curable,  this,  I  am  persuaded, 
will  be  the  best  cure ;  and  supposing  that  the 
mischief  is  not  local,  but  that  the  whole  body  is 
infected  either  with  an  hereditary,  or  an  acquired 
cancerous  taint,  I  am  not  aware  that  the  distem- 
per would  either  more  certainly,  more  rapidly,  or 
more  painfully  put  an  end  to  life,  for  having  made 
this  most  promising  effort  to  elude  its  power. 

If  the  want  of  resolution  in  the  patient  to  have 
the  scirrhus  taken  out,  or  the  delay  occasioned 


S40  Commentaries  on  the 

by  the  trial  of  various  specifics,  which  had  pro- 
mised much,  and  performed  nothing,  have  suffer- 
ed the  hardness  gradually  to  occupy  the  whole 
breast,  and  to  ulcerate,  with  a  great  increase  of 
pain  in  the  part,  and  flying  pains  over  the  whole 
body,  and  hectic  fever,  and  loss  of  appetite,  of 
flesh,  and  of  strength,  (at  which  state  it  may  ar- 
rive in  a  few  years,  or  in  a  few  months)  what  is 
then  to  be  done  ?  Now  even  in  this  state,  if  the 
schirri  have  not  spread  too  far  under  the  arm-pit 
to  be  all  cut  out,  the  time  of  the  operation  is  in- 
deed almost  over,  but  not  entirely  ;  for  in  these 
almost  hopeless  circumstances  I  have  known  it 
performed  with  success.  It  can  be  no  wonder, 
"when  done  so  late,  that  the  operation  often  fails, 
and  that  the  wound  should  either  never  heal,  or 
that  fresh  schirri  should  arise  after  it  has  been 
healed  ;  still,  there  will  be  some  advantages  in  giv- 
ing a  little  respite  to  the  patient,  and  her  atten- 
dants, from  the  offensiveness  of  a  foul  ulcer,  by 
removing  at  once  the  putrid  mass. 

Where  the  cancer  is  spread  deeply. under  the 
arm,  and  the  whole  ami  is  swelled  from  the  ob- 
struction of  the  lymphatic  glands,  with  loss  of  ap- 
petite, and  strength,  and  shortness  of  breath,  and 
every  sign  of  inevitable  death,  all  which  then  re- 
mains to  be  done,  is  to  keep  the  ulcer  with  proper 
dressings,  (by  washing  it  with  water  impregnated 
with  fixed  air,  or  by  the  application  of  a  carrot 
poultice,  in  which  this  air  abounds)  as  clean,  and 
as  quiet,  as  may  be  ;  and  to  sooth  the  pains,  and 
procure  rest  with  as  much  opium  as  is  necessary 
for  these  purposes.  The  degree  of  pain  attend- 
ing a  cancer  is  extremely  various ;  in  some  it  ap- 


History  and  Cure  of  Diseases.        S4ji 

pears  to  be  great,  and  in  others  but  slight  and  in- 
considerable. 


CHAPTER  62. 

Menstrua, 

The  regular  and  natural  state  of  the  menstrual 
flux  in  women  is  well  known  to  be  intimately 
connected  with  their  health.  They  seldom  suf- 
■fer  much  from  any  distemper  without  experienc- 
ing some  deviations  in  this  particular  from  the  or- 
derly course  of  nature ;  and  the  irregularities  of 
this  evacuation,  if  they  continue  long,  except  in 
pregnancy,  will  most  commonly  have  bad  effects 
upon  the  general  health ;  but  these  irregularities 
are  perhaps  oftcner  a  sign,  than  the  cause  of  oth- 
er distempers. 

The  proper  ticfte  of  the  first  appearance  of  the 
■menstrua,  is  from  the  age  of  twelve  years  to  iif- 
*teen.  Some  shew  of  them  has  been  known  in 
girls  of  eight  or  nine  years,  and  even  of  five 
years  ;  but  1  never  knew  an  instance  of  their  con- 
tinuing to  return  regularly,  when  they  began 
sooner  than  the  tenth  year  of  life.  These  very 
early  appearances  have  not  been  attended  with 
any  ill  consequences,  and  required  only  a  little 
rest  and  patience. 

When  the  catamenia  begin  first  to  flow  at  the 
proper  time,  it  happens  to  many  young  women, 
that  for  the  first  year  or  two  they  will  not  go  op 
.31 


)34S  Commentaries  on  the 

to  observe  their  exact  periods,  without  either  ex- 
ceeding, or  falling  short  of  the  just  quantity  :  in 
this  case,  and  likewise  where  thej  delay  to  come 
on  for  one  or  two  years  beyond  the  usual  time,  it 
is  better  not  to  be  too  hasty  in  prescribing  medi- 
cines ;  for  as  the  strength  of  the  body  increases, 
nature  will  most  usually  set  all  such  little  anoma- 
lies to  right,  where  there  is  no  other  distemper, 
and  in  the  meantime  the  constitution  will  suffer 
no  harm. 

The  case  is  very  different  after  women  are 
come  to  their  full  growth,  and  strength  ;  for  eve- 
ry function  of  life  will  suffer,  and  often  in  a  vio- 
lent manner,  from  great  disorders  of  this  evacua- 
tion ;  yet  nature  has  allowed  some  latitude,  so 
that  no  inconvenience  will  arise  from  the  catame- 
nia  coming  a  week  sooner  or  later,  staying  a  day 
less  or  more  :  all  which  we  hnd  by  experience  to 
be  very  consistent  with  good  health. 

There  are  constitutions,  in  which  not  only  mis- 
carriages, difficult  births,  and  frequent  lyings-in  : 
but  even  terrour,  uneasiness  of  mind,  and  mode- 
rate exercise,  occasion  such  a  loss  of  uterine  blood, 
as  hatli  brought  on  great  pains  in  the  head,  back, 
and  bowels,  and  a  dangerous  weakness.  Some- 
times without  any  apparent  cause  the  menses 
have  exceeded  the  healthy  limits,  by  returning 
too  often,  or  by  continuing  to  flow  too  long,  or  in 
too  great  abundance.  These  haemorrhages  have 
been  so  lasting  as  to  have  continued  for  many 
months  together;  or  so  profuse,  as  by  their  abun- 
dance to  have  threatened  immediate  death.  But 
these  cases,  where  pregnancy  was  not  concerned, 


History  and  Cure  of  Diseases,        S43 

have  been  usually  more  alarming  than  dangerous  ; 
for  among  the  many  instances  of  excessive  flood - 
ings  which  I  have  known,  I  have  remarked  only 
two,  who,  without  being  pregnant,  have  bled  till 
they  were  exhausted,  and  died. 

The  menstrual  discharge  gradually"  lessens  be- 
tween the  fortieth  and  fiftieth  year ;  and  some- 
times misses  for  two  or  three  periods,  and  after 
giving  warning  in  this  manner  for  a  year  or  two, 
it  then  totally  ceases.  This  seems  to  be  the  most 
natural  way  of  its  going  off.  But  it  very  com- 
monly happens,  that  at  this  time  the  uterine  flux, 
instead  of  lessening,  returns  more  frequently,  and 
with  more  violence  ;  so  that,  except  in  cases  of 
pregnancy,  the  greatest  uterine  ha3morrhages 
have  been  observed  at  the  time  when  nature  is 
about  ceasing  to  supply  them  any  longer. 

Young  unmarried  women  sometimes  have  their 
monthly  evacuation  too  often,  and  in  too  great 
quantity,  but  they  are  more  subject  to  having  it 
flow  too  sparingly,  or  to  its  not  observing  the  re- 
gular periods,  or  to  its  being  totally  obstructed. 

The  obstruction  of  the  catamenia  has  been  im- 
puted by  the  persons  themselves  to  wetting  their 
feet  at  the  time  of  this  flux,  to  lerrour,  and  to  fre- 
quent venaesections.  The  injury  done  by  diflicult 
births  more  frequently  occasions  floodings,  but 
has  sometimes  been  followed  by  obstructions,  es- 
pecially if  the  milk  continued  to  come  into  the 
breasts,  which  it  has  been  known  to  do  for  seve- 
ral months  after  the  child  had  been  weaned,  or 
though  it  had  never  sucked.      Somtt  distemper  of 


S44  Commentaries  on  the 

the  parts  concerned,  or  a  mal-conformation  pro- 
bably occasions  irregularities  or  obstructions  in 
some,  especially  in  those,  for  such  there  are,  who 
never  experienced  this  eracuation.  But  perhaps 
obstructions  are  most  frequently  owing  to  other 
antecedent  disorders  of  the  health,  which  by 
weakening  the  powers  of  life,  and  hindering  the 
due  nourishment  of  the  body,  reduces  it  to  such 
an  exhausted  state,  as  to  afford  no  supply  for  this 
evacuation.  If  a  woman  ever  so  regular  in  this 
particular  happen  to  have  a  long  fever,  the  men- 
strual discharge  is  almost  always  obstructed.  So 
likewise  consumptive  women  in  the  last  stage  of 
their  distemper,  cease  to  have  their  courses  re- 
turn, merely  from  their  weak  and  exhausted  con- 
dition. 

The  effects  which  I  have  noted  of  suppressed 
menstruation,  where  it  was  not  wholly  dependent 
upon  other  disorders,  are  a  weight  and  pain  of 
the  head,  giddiness,  a  pale,  and  often  bloated  ap- 
pearance of  the  face,  flatulence,  sickness,  loss  of 
appetite,  indigestion,  pains  and  a  sense  of  fulness 
in  the  stomacn  and  bowels,  a  swelling  of  the  bel- 
ly, which  may  be  mistaken  for  pregnancy,  pains 
of  the  breast,  sides,  back,  and  knees,  swelling  of 
the  legs,  loss  of  flesh,  sleepiness,  flushings,  lassi- 
tude, fainting,  melancholy,  and  the  whole  train  of 
hysteric  symptoms.  The  fluor  albus  has  been  a 
substitute  for  the  menses,  returning  regularly  for 
several  months.  The  catamenia  nave  in  more 
uncommon  cases  been  represented  by  a  periodical 
bleeding  of  the  nose,  or  by  a  vomiting  of  blood. 
Barrenness  is  an  usual  attendant  upon  any  consi- 
derable deficiency  of  the    menses  ,*   yet   I   have 


History  and  Cure  of  Diseases,     S4^ 

Known  a  wotnan  have  children,  who  was  not 
above  twice  in  the  year  in  the  way  in  which  she. 
should  have  been  every  month. 

The  menstrua  are  often  regular  both  as  to  time 
and  quantity,  but  attended  always  with  so  much 
pain  about  the  womb,  as  to  occasion  greater  pre- 
sent misery,  than  any  other  irregularity,  though 
with  less  hurtful  consequences.  This  pain  is 
most  usually  felt  on  the  first  day,  and  sometimes 
only  for  the  first  six  hours,  and  is  then  so  violent, 
as  to  make  the  persons  keep  their  beds.  In  two 
or  three  instances  I  have  known  it  not  come  on 
till  the  second  day.  A  strangury  has  begun  to 
be  troublesome  only  on  the  last  day.  Pains  of 
the  head,  limbs,  back,  and  stomach,  and  particu- 
larly of  the  breasts,  which  are  usually  fuller  at 
this  time,  together  with  sickness,  and  tenesmus, 
with  all  kind  of  hysteric  evils,  harass  some  wo'- 
men  during  the  whole  time  of  their  menstruation. 

The  catamenia  in  the  ordinary  course  of  nature 
cease  between  the  fortieth  and  fiftieth  year.  A 
very  few  have  lost  them  before  the  fortieth  (and 
one  even  before  the  thirtieth  year  of  life)  and  yet 
enjoyed  a  good  state  of  health  afterwards,  and 
have  lived  long.  I  have  remarked  some,  who 
have  continued  to  have  them  till  they  were  sixty 
years  old.  They  have  become  irregular  in  their 
time,  and  quantity,  not  only  a  few  months,  which 
is  their  common  method,  but  even  for  a  few  years, 
before  they  have  entirely  disappeared ;  and  after 
ceasing  three  or  four  years  have  been  known  to 
return.  The  animal  powers,  while  the  menses 
are  preparing  to  cease,  seem  to  be  greatly  op- 


;S46  Commentaries  on  the 

pressed,  and  less  able  to  keep  any  constitutional 
disorder  under,  or  to  exert  themselves  in  shak- 
ing oflf  any  ^accidental  illnesses,  which  therefore 
at  this  time  are  unusually  troublesome,  and  less 
disposed  to  yield  to  their  proper  remedies  ;  so 
that  any  lurking  gout,  or  madness,  or  cutaneous 
diseases,  have  often  taken  the  advantage  of  this 
weak  state  of  the  health,  and  have  established  a 
lasting  tyranny. 

It  is  probable  that  the  menstrua  leave  most  wo- 
men in  a  kindly  manner,  without  exciting,  or  creat- 
ing any  disorders,  which  require  the  assistance  of 
medicine.  But  some,  upon  the  occasion  of  this 
great  change  in  the  animal  economy,  experience 
a  variety  of  disorders.  The  most  common  is  that 
of  excessive- floodings,  attended  sometimes  with 
faintings,  and  convulsions,  which  though  hardly 
ever  immediately  fatal,  yet  are  always  very  alarm- 
ing, and  have  been  succeeded  by  dropsical  swell- 
ings of  the  legs,  of  the  abdomen,  and  of  the  whole 
body,  and  by  a  broken  state  of  health,  from  which 
some  are  with  great  difficulty,  and  others  never 
recovered.  In  the  intervals  of  these  discharges, 
the  fluor  albus  often  conspires  to  drain  away  the 
strength.  Sleepiness,  numbnesses,  and  palsies 
have  followed,  and  probably  have  been  occasion- 
ed by  these  weakening  complaints.  Cramps,  and 
wandering  pains,  have  been  the  next  most  gene- 
ral attendants  upon  this  revolution  in  the  health 
of  women ;  which  may  perhaps  be  the  effect  of  a 
great  loss  of  blood,  where  the  catamenia  have 
gone  off  in  this  manner  ;  for  I  have  observed  the 
same  after  other  imoioderate  bleedings.  Giddi- 
ness, and  shortness  of  breath,  belong  also  to  this 


History  and  Cure  of  Diseases,       347 

train  of  evils  :  but  no  part  seems  to  suffer  more 
than  the  stomach  and  bowels,  which  are  apt  to  be 
afflicted  at  the  time  of  this  change  with  pains, 
sickness,  loss  of  appetite,  heartburn,  flatulence, 
an  uneasy  sense  of  fullness,  the  tenesmus,  and 
piles.  Every  hysteric  symptom  has  joined  itself 
with  these  disorders.  The  legs  at  this  time  of  life 
are  more  peculiarly  liable  to  inflammations,  and 
obstinate  ulcers.  It  is  less  to  be  wondered  at  that 
some  constitutions  sink  under  the  greatness,  or 
multiplicity  of  such  evils,  than  that  others,  after 
struggling  three  or  four  years  under  several  of 
the  worst  of  them,  have  happily  been  restored, 
and  their  health  perfectly  established.  Perhaps 
when  the  menstrua  are  fully  over,  after  escaping, 
or  surmounting  these  difiiculties,  the  health  of  a 
female  becomes  firmer  than  ever,  and  she  bids 
more  fairly  for  long  life,  than  a  man  of  the  same 
age. 

After  the  menses  have  disappeared  at  the  natu- 
ral time,  and  have  seemed  for  many  years  to  be 
totally  gone,  they  have  in  some  women  returned 
beyond  all  expectation.  This  has  happened  at 
the  sixtieth,  at  the  seventieth,  and  even  at  the 
eightieth  year  of  life  ;  and  consequently  after  they 
had  ceased  for  twenty  or  thirty  years.  In  some 
of  these  they  have  observed  their  ordinary  pe- 
riods, as  they  had  done  in  the  earlier  part  of  life  ; 
but  these  unseasonable  discharges  have  oftener 
been  irregular  in  their  returns,  too  abundant  in 
quantity,  or  joined  with  the  fluor  albus.  The  ca- 
tamenia  have  in  this  manner  returned  and  conti- 
nued for  seven  years  from  no  apparent  cause,  and 
without  any  evident  injury  to  the  health.     This 


348  Commentaries  on  the 

effect  however  most  usually  proceeds  from  some 
unnatural  state  of  the  womb ;  and  if  these  dis- 
charges be  accompanied  with  great  pains  about 
the  OS  pubis,  the  hips,  and  the  loins  ;  and  if  in  their 
intervals  an  offensive  discoloured  liquor  drain 
away,  they  may  justly  be  charged  to  an  ulcer  of 
the  womb,  which  usually  becomes  cancerous,  and 
incurable. 

A  profuse  uterine  haemorrhage  may  be  occa- 
sioned by  something  in  the  womo,  which  must  be 
brought  away  before  the  bleeding  can  be  restrain- 
ed. In  other  cases  the  patient  should  be  kept 
quiet  and  cool ;  the  body  must  be  rather  inclining 
to  purging  than  costiveness ;  and  liquors  should 
be  frequently  sipped  acidulated  with  lemon-juice, 
or  acicl  of  vitriol.  A  dram  or  two  of  syrup  of 
poppies  will  often  be  of  great  use  in  soothing  a 
restlessness  or  anxious  state  of  mind,  which  m- 
crease  the  malady.  A  very  able  and  experienced 
physician*  has  proposed  to  me  in  consultation, 
the  giving  of  one  scruple  of  flowers  of  sulphur 
morning  and  night  to  such  patients,  where  he 
judged  it  to  be  as  useful,  as  in  an  immoderate 
flow  of  the  piles.  The  Peruvian  bark  is  seldom 
omitted  among  the  remedies  prescribed  in  this 
case ;  and  other  styptic  substances,  as  alum,  galls, 
and  oakbark,  are  often  joined  with  it,  as  well  as 
given  without  it.  If  I  were  satisfied  that  experi- 
ence of  the  good  effects  of  such  medicines  had  es- 
tablished their  reputation,  no  reasoning,  however 
specious,  would  make  me  hesitate  to  confide  in 
them  ;  but  if  they  be  used  because  of  the  sense  of 

*  Sir  Edward  Wiliuot. 


History  and  Cure  of  Diseases.       249 

astringencj  which  they  impart  to  the  tongue,  it 
may  be  questioned  whether  this  quahty  can  afford 
us  a  reasonable  expectation  of  their  stopping  the 
bleeding,  in  a  part  which  they  cannot  reach  till 
after  they  have  been  diluted  by  a  great  quantity 
of  various  liquids  :  and  what  degree  of  effectual 
stypticity  can  they  then  be  supposed  to  possess, 
when  they  are  not  readily  able  to  restrain  the 
bleeding  of  a  small  wound  made  by  a  leech, 
though  the  powder  of  these  substances  be  imme- 
diately applied  to  the  orifice  ?  I  am  cautious  of 
opening  a  vein,  for  reasons  given  in  the  second  vo- 
lume of  the  Medical  Transactions,  Query  the 
fourth.*  One  scruple  of  alum  has  been  given 
every  day  with  safety  :  but  I  remember  to  have 
seen  one  woman  near  fifty  years  old  in  a  bad  state 
of  health,  whose  belly  and  pudenda  were  swelled 
in  a  remarkable  manner,  so  as  almost  to  close  up 
the  vagina,  all  which  was  attributed  (perhaps 
without  reason)  to  checking  an  uterine  haemor- 
rhage by  taking  daily  ten  grains  of  alum.  Four 
grains  of  saccharum  Saturni  stopped  a  pjofuse 
bleeding,  as  I  was  informed,  in  four  hours ;  but 
the  violent  and  lasting  colic  which  I  saw  occasion- 
ed by  this  preparation  of  lead,  ought  to  make 
every  one  dread  its  use.  Thirty  drops  of  tinctura 
Saturnina  had  been  taken  every  day  by  a  woman 
for  a  like  purpose,  whom  I  afterwards  saw  la- 
bouring under  a  similar,  though  less  violent,  dis- 
order of  the  bowels.  Steel  waters  have  in  seve- 
ral instances  increased  the  haemorrhage.  •  Camo- 
mile jflowers  have  done  the  same :  and  so  likewise 


*  See  Appendix. 
32 


2d0  Commentaries  on  the 

has  \y'incr  down ;  contrarily  to  what  1  should  have 
supposed. 

The  opposite  disorder  to  flooding,  namely, 
where  the  catamenia  are  too  sparing,  or  totally 
obstructed,  may  be  occasioned,  as  was  before  ob- 
served, by  a  variety  of  other  complaints,  the  re- 
medies of  which  will  be  the  hkeliest  means  of  rec- 
tifying all  the  ailments  dependent  upon  them. 
But  where  there  appears  no  ill  health,  except 
what  is  the  effect,  rather  than  the  cause  of  the 
partial  or  total  obstruction,  there  stimulating,  bit- 
ter, aloetic,  and  chalybeate  medicines  are  what 
physicians  from  general  experience  seem  to  have 
rested  in ;  various  forms  of  which  are  to  be  found 
in  all  pharmacopoeias.  The  black  hellebore  root 
claims  some  specific  virtue  as  an  emmenagogue, 
of  which  in  my  practice  I  have  never  met  with 
any  decisive  proof.  Camomile  flowers  undoubt- 
edly possess  it  with  relation  to  particular  women; 
for  1  have  known  more  than  one,  in  whom  they 
constantly  brought  on  some  degree  of  an  uterine 
haemorrhage,  at  whatever  time  of  the  month  they 
^vere  taken.  Warm  bathing,  putting  the  feet  in 
warm  water,  and  sitting  over  its  vapour  for  half 
an  hour  every  day,  have  been  used  successfully. 
Electrifying,  when  employed  for  other  purposes, 
has  frequently  bi ought  on  the  menses  before  their 
time.  But  there  are  too  many  cases  in  which  all 
these  means  have  been  found  ineffectual. 

The  pains,  which  several  women  experience 
during  some  part  of  the  menstrual  flux,  are  safely 
mitigated  with  opium  ;  and  such  persons  should 
always  have  in  readiness  half  a  grain  or  a  grain 


History  and  Cure  of  Diseases.      S5  i 

of  opium,  to  be  taken  as  soon  as  the  pain  comes 
on,  and  to  be  repeated  once  or  twice  if  the  pain 
require,  at  the  distance  of  half  an  hour.  This 
has  been  very  frequently  given  without  checking, 
or  in  any  manner  deranging  this  evacuation.  To 
those,  whose  stomach  will  not  bear  opium,  it  has 
been  given  as  safely  in  a  clyster.  The  tincture 
of  opium  has  not  appeared  to  be  without  some  ef- 
fect, when  only  rubbed  in  by  a  warm  hand  over 
the  abdomen.  Warm  bathing,  sitting  over  the 
steam  of  warm  water  a  few  mornings  before  the 
expected  return  of  the  catamenia,  Bath  waters, 
both  externally  and  internally,  have  all  been  em- 
ployed against  this  complaint,  and  with  advan- 
tage. 

At  the  time  of  life,  when  it  is  according  to  the 
course  of  nature  that  the  menstrual  flux  should  en- 
tirely cease,  if  it  go  off  gradually  and  without  any 
troublesome  symptoms,  which  it  most  frequently 
does,  no  medicines  will  be  wanted,  nature  herself 
being  fully  sufficient  to  bring  about  this  revolution 
without  any  tumult  or  commotion.  However, 
some  attention  may  bo  useful  in  keeping  the  body 
from  any  tendency  to  costiveness,  by  taking  occa- 
sionally a  little  lenitive  electuary,  or  some  purg- 
ing water.  If  the  menses  leave  a  woman  very 
abruptly,  and  either  from  this  cause,  or  from  any 
other,  there  should  come  on  at  this  time  vertigos, 
sleepiness,  numbnesses,  or  pains  of  the  head,  with 
a  sense  of  fulness,  the  taking  away  of  six  ounces 
of  blood  by  cupping  once  a  month,  as  long  as 
these  complaints  remained,  has  been  experienced 
with  success.  Whatever  other  disorders  may 
chance  to  shew  themselves,  they  must  be  treated 


35S  Commentaries  on  the 

with  their  usual  remedies.  In  constitutions,  which 
have  been  subject  to  cutaneous  diseases,  or  which 
may  be  judged  to  be  in  danger  from  palsies,  or 
some  hereditary  cancerous  taint,  an  issue  may  be 
advisable ;  which  in  other  cases,  as  far  as  I  have 
observed,  may  very  safely  be  omitted. 

A  return  of  the  menstrual  flux  to  old  women, 
after  having  left  them  for  some  years,  may  either 
be  excessive,  or  it  may  be  a  symptom  of  an  ulcer- 
ed, or  cancerous  womb ;  and  then  the  proper  re- 
medies for  these  ails  must  be  employed  :  but  if  it 
continued  to  make  its  visits  in  a  regular  manner, 
as  it  has  happened  to  some  women,  and  the  health 
appear  in  no  respect  to  suffer,  such  persons  will 
stand  in  need  of  no  assistance  from  physicians. 


CHAPTER  63. 

MorbillL 

I  PURPOSE  first  to  give  a  history  of  the  measles 
in  a  single  patient,  who  had  a  regular  and  mid- 
dhng  sort,  and  in  whom,  on  account  of  the  fair- 
ness of  the  skin,  it  was  easy  to  observe  with  pre- 
ciseness  the  appearance  and  disappearance  of  the 
eruption  :  after  which  I  will  relate  the  varieties, 
which  I  have  noted  in  a  considerable  number  of 
other  patients. 

On  the  first  day 

The  symptoms  were  very  slight  shiverings,  a  fai- 
lure of  appetite,  some  degree  of  sickness,  a  quick- 


History  and  Cure  of  Diseases,  258 

iiess  of  pulse,  a  drj  cough,  no  sneezing,  no  tears, 
nor  redness  of  the  eye-lids,  a  very  little  thirst, 
and  pains  in  the  limbs. 

2d.  The  night  was  quiet  without  any  great 
complaint,  the  appetite  still  fails,  and  the  cough 
and  pulse  are  as  before. 

3d.  This  day  all  is  much  the  same  as  yester- 
day. 

4th.  A  faint  eruption  is  to  be  seen  by  attentive 
looking  upon  the  face :  red  spots  are  much  more 
visible  about  the  throat.  The  fever,  restlessness, 
and  want  of  appetite,  are  increased.  The  cough 
is  rather  less.  The  eyes  are  less  impatient  of 
light.  There  is  no  vomiting.  The  face  burns, 
and  is  unusually  flushed. 

5th.  Faintly  red  spots  are  sprinkled  over  the 
chin,  and  (at  a  greater  distance  from  one  anoth- 
er) over  the  rest  of  the  face.  The  spots  are  of 
an  irregular  figure,  and  are  much  redder  about 
the  throat  and  breast.  The  fever  and  cough  re- 
main. There  is  yet  no  appearance  of  the  erup- 
tion on  the  hands  and  arms. 

6th.  The  spots  of  the  face  rise  a  little  above 
the  skin,  so  as  to  afford  a  perceivable  roughness 
to  the  touch,  and  are  visibly  formed  of  many  mi- 
nute heads  much  less  than  a  millet  seed.  On  this 
day  the  eruption  begins  to  appear  on  the  arms. 
The  fever,  and  restlessness,  and  impatience,  are 
considerably  increased.  The  cough  is  very  trou- 
blesome, but  without  any  difficulty  of  breathing. 


S54j  Commentaries  on  the 

The  eyes  are  weak,  the  eye-lids  are  swelled. 
There  is  a  total  loathing  of  all  food.  Towards 
evening  the  symptoms  grow  worse,  and  with  some 
oppression  of  the  breath.  The  spots  in  the  face 
are  of  a  lively  red.  Yesterday  the  menses  came 
on  before  their  regular  time,  and  lasted  only 
twenty-four  hours. 

7th.  Bleeding  yesterday  gave  some  relief.  The 
night  was  a  little  quieter  ;  but  the  fever  and  anxie- 
ty ar.e  very  little  abated.  The  eruption  in  the 
face  is  paler.  The  skin  begins  to  itch  in  a  trou- 
blesome manner. 

8th.  The  symptoms  are  much  abated,  and  the 
appetite  begins  to  return.  The  eruption  is  more 
faint.  The  languor  and  fever  are  now  and  then 
much  complained  of. 

9th.  The  night  was  tolerably  quiet,  and  the  pa- 
tient is  now  a  little  revived;  but  still  there  are  in- 
tervals of  fever,  and  uneasiness,  and  lowness, 
which  are  much  relieved  by  a  repetition  of  bleed- 
ing. 

10th.  The  night  was  very  good.  The  erup- 
tion has  totally  disappeared,  and  hardly  any  fever 
remains. 

11th.  Some  cough  still  remains. 

12th.  The  sleep  and  appetite  are  returned,  but 
the  cough  still  remains ;  and  so  it  continued  to  do 
for  three  or  four  days  more :  bleeding  much  weak- 


History  and  Cure  of  Diseases,       255 

ened  it,  and  in  a  few  days  more  it  went  entirely 
away. 

I  shall  now  proceed  to  relate  some  diversities 
in  the  symptoms,  which  have  attended  the  several 
stages  of  the  measles,  collected  from  a  considera- 
ble number  of  patients. 

Some  have  had  weak  and  watery  eyes  one  or 
two  days  before  the  eruption,  and  sometimes  the 
same  sharp  humour  has  irritated  the  nostrils,  and 
occasioned  sneezing.  The  cough  most  usually 
has  come  on  two  or  three  days  before  the  erup- 
tion; but  it  has  been  known  to  precede  the  mea- 
sles seven  or  eight  days,  and  it  generally  did  so 
in  the  year  1753,  when  they  were  remarkably 
epidemical.  Pains  of  the  throat  and  head  and 
back,  have  not  been  unusual  in  this  preparatory 
stage.  One  person  in  particular  had  a  most  ex- 
cruciating pain  in  the  back,  which  continued  a 
day  or  two  after  the  eruption.  Sickness  and  vo- 
miting as  well  as  want  of  appetite,  have  come  on 
at  the  beginning,  and  lasted  till  the  middle,  or  de- 
cline of  the  distemper.  Some  have  been  so  for- 
tunate as  to  have  the  measles  appear  after  suffer- 
ing so  very  little  from  (e\er  or  any  of  the  prepa- 
ratory symptoms,  that  they  could  hardly  say  they 
had  been  ill.  The  longer  the  preparatory  symp- 
toms continued,  and  the  worse  they  were,  so  much 
the  less  mild  has  the  distemper  proved. 

The  first  day  of  the  eruption. 

In  one  or  two  patients  I  have  seen  the  eruption 
appear  upon  the  arms  on  the  first  day,  a  few 


256  Commentaries  on  the 

hours  after  its  having  been  observed  on  the  face 
and  neck.  But  it  so  seldom  happens  that  the 
arms  and  hands  shew  any  mark  of  the  distemper 
before  the  second  day  of  its  being  visible  on  the 
face,  that  possibly  in  those  instances  the  eruption 
on  the  face  might  have  been  earlier  than  it  was 
taken  notice  of.  In  one  patient  no  cough  nor 
sneezing  v^^as  complained  of  till  the  day  of  the 
eruption.  The  appearance  of  this  distemper  does 
not  at  all  mitigate  the  symptoms,  as  it  does  in  the 
small  pox.  One  patient  was  seized  with  a  spit- 
ting on  this  day,  which  continued  to  teaze  him  for 
forty-eight  hours,  without  suffering  him  to  rest  at 
all  by  day,  or  to  sleep  by  night ;  the  cough  in  the 
mean  time  almost  ceased,  and  all  the  other  symp- 
toms were  as  mild,  as  in  a  favourable  sort  of  the 
measles. 

2d.  I  have  scarcely  ever  observed  the  eruption 
on  the  hands  and  arms  fail  of  being  perceived  in 
the  course  of  this  day;  and  where  it  has  been 
supposed  to  have  been  deferred  a  day  longer,  it 
is  most  probable  that  there  was  an  errour  in  dat- 
ing the  beginning  of  the  eruption.  Once  or 
twice  the  distemper  has  been  observed  never  to 
have  reached  the  arms,  which  throughout  the 
whole  of  it  shewed  none  of  the  usual  spots.  On 
this  day  the  measles  appear  in  full  vigour  upon 
the  face,  but  without  any  rehef  of  the  symptoms, 
which  are  often  rather  aggravated,  and  a  diar- 
rhoea has  been  joined  to  them,  but  without  any 
danger.  The  nose  has  bled  about  this  time,  and 
the  eye-lids  have  been  so  swelled,  that  for  twen- 
ty-four hours  they  could  not  be  opened. 


Uistory  and  Cure  of  Diseases.        257 

3cl.  Now  the  eruption  usually  appears  very 
lively  on  the  other  parts,  but  is  a  little  deadened 
upon  the  face ;  yet  in  several  the  marks  on  the 
face  have  been  at  this  time  of  as  bright  a  red  as 
ever.  In  others  I  have  observed  them  to  disap- 
pear entirely  on  this  day,  and  all  the  other  symp- 
toms likewise  to  retreat.  However,  the  cough 
and  fever  most  commonly  continue  the  same ; 
some  patients  have  thought  them  a  little  better, 
others  a  little  worse.  Where  the  eyes  have  been 
very  watery,  and  the  eye-lids  red,  they  have  still 
remained  so  to  this  time  ;  and  1  have  noted  a  very 
troublesome  and  constant  sneezing,  which  first 
came  on  upon  this  day.  A  child  ^ye  years  old 
became  comatose  the  third  day  of  the  eruption, 
and  died  the  next. 

4tb.  The  spots  in  most  patients  become  of  a 
much  paler  colour  in  the  face,  and  begin  to  grow 
fainter  in  the  breast  and  arms  of  some;  in  others 
the  arms  are  of  as  high  a  colour  as  ever  :  yet  in 
more  persons  than  one  I  have  observed  no  dimi- 
nution of  the  colour  even  in  the  face  on  this  day. 
Those,  who  have  shewn  the  least  remains  of  the 
eruption  at  this  time  (and  some  have  shewn  hard- 
ly atiy)  have  appeared  the  best ;  and  in  those, 
where  it  was  still  in  undiminished  vigour,  the 
couirh  and  fever  have  been  the  worst.  The  coucrh 
in  several  is  very  sensibly  abated  on  this  day; 
others  find  both  cough  and  fever  as  bad  as  ever. 
The  eyes  seldom  continue  to  water  any  longer, 
except  where  they  have  been  so  hurt  by  this  ill- 
ness, as  to  continue  weak  for  a  long  time  after. 
The  sneezinjr  has  lasted  till  this  time  :  but  this 
las  very  rarely  happened.  The  face  now  begins 
33 


S58  Commentaries  on  the 

to  be  branny  and  itch,  which  itching  is  propagat- 
ed over  the  whole  body,  so  as  to  be  the  chief,  or 
only  complaint.  The  catamenia  have  appeared 
on  this  day  before  their  regular  time. 

5th.  The  marks  are  very  pale  both  in  the  face 
and  arms,  though  perceivable  in  some  ;  in  others 
they  are  quite  gone,  the  appetite  returns,  and 
the  patients  seem  well.  Those  patients  have 
been  the  worst,  in  whom  most  of  the  eruption 
^vas  still  remaining.  The  cough  in  some  is  much 
better,  in  others  it  is  quite  gone ;  but  several  are 
teazed  with  it  a  long  time  after  the  distemper  is 
ended.  The  menses  have  made  their  appearance 
on  this  day,  out  of  their  regular  course. 

6th.  The  vestiges  of  the  eruption  have  been 
still  visible  on  the  arms,  and  even  in  the  faces  of 
a  few  patients,  with  a  considerable  degree  of 
cough,  sneezing,  hoarseness,  and  fever ;  and  I 
have  once  or  twice  seen  soij)e  marks  of  the  mea- 
sles so  late  as  on  the  tenth  daj  of  the  eruption; 
but  on  the  sixth  day  most  patients  are  tolerably 
well  recovered,  except  in  those  unfortunate  cases, 
in  which  the  fever,  instead  of  abating,  begins  at 
this  time  to  increase,  and  continues  to  do  so,  until 
it  have  destroyed  the  patient.  In  others,  who 
escape  this  immediate  danger,  the  lungs  are  some- 
times so  injured  by  this  distemper,  that  a  lasting 
cough  succeeds  ;  and  sometimes  a  pulmonary  con- 
sumption. Weak  eyes,  inflamed  eye-lids,  glandu- 
lar tumours,  and  many  other  scrofulous  appear- 
ances have  followed  the  measles ;  whether  they 
were  formed  by  them,  or,  the  seeds  being  before 
in  the  constitution,  were  only  excited  by  this  dig- 


History  and  Cure  of  Diseases.     S59 

temper;  or  possibly  the  appearance  of  scrofulous 
symptoms  was  wholly  owing  to  other  causes,  and 
would  have  come  on  at  this  time  though  there 
had  been  no  measles. 

Bleeding  may  be  used  at  any  time  of  the  mea- 
sles, and  is  always  beneficial  where  the  symptoms 
are  very  distressing,  particularly  if  there  is  an 
oppression  of  the  breath,  to  which  every  stage  of 
this  distemper  is  liable.  Bleeding,  together  with 
such  medicines  as  the  occasional  symptoms  would 
require  in  any  other  fever,  is  the  whole  of  the  me- 
dical care  requisite  in  the  measles.  The  flowing 
of  the  menses  ought  to  be  no  objection  to  the 
opening  a  vein,  if  the  cough  and  shortness  of 
breath  make  it  otherwise  advisable.  I  never  saw 
any  bad  consequences  from  bleeding  a  woman  in 
these  circumstances ;  but  the  greatest  danger 
might  attend  the  omitting  to  do  it  in  a  violent 
cough,  or  oppression  of  the  breath. 

The  measles  are  far  less  dangerous  to  pregnant 
women,  than  the  small  pox.  I  have  attended  se- 
veral, who  were  greatly  harassed  by  the  violence 
of  all  the  usual  symptoms  in  this  illness,  but  I  ne- 
ver knew  it  make  one  woman  miscarry,  or  be  in 
more  danger  on  account  of  the  pregnancy. 

Is  not  this  distemper  worse  in  proportion  to  the 
quantity  of  eruption,  as  in  the  small  pox  ? 

The  preparatory  symptoms  of  the  measles  have 
appeared  thirteen  days  after  the  infection  had 
probably  been  received.  In  two  others  there  was 
the  greatest  reason  to  judge,  that  they  began  to 


N 


a60  Commentaries  on  tht 

come  on  fourteen  days  after  the  time  of  infection. 
In  four  others  the  infection  seemed  not  to  have 
lain  dormant  above  ten  dajs. 

An  infant  sucked  a  nurse  till  the  measles  ap- 
peared upon  her,  and  then  was  taken  away,  and 
escaped  catching  the  distemper :  is  it  therefore, 
like  the  small  pox,  not  infectious  in  its  first  stage  ? 
or  did  the  incapacity  of  this  child's  receiving  the 
measles  at  that  time  arise  from  some  other  cause  ? 


CHAPTER  64. 

Narium  Hcemorrhagia, 

A  SPONTANEOUS  bleeding  of  the  nose  more  par- 
ticularly belongs  either  to  children,  or  to  such  as 
have  past  the  meridian  of  life.  In  children  it  sel- 
dom comes  to  any  excess ;  but  in  adults  will  con- 
tinue so  long,  or  with  such  violence,  that  many 
pounds  of  blood  will  be  lost,  or  the  person  faint 
away. 

Weakly  children  seem  more  subject  to  it,  than 
the  strong ;  and  among  adults,  beside  its  being  an 
usual  attendant  upon  the  diseases  of  the  liver  in 
hard-drinkers,  it  often  accompanies  the  gout,  head- 
ach,  giddiness,  numbnesses,  a  broken  state  of  the 
health,  and  threatenings  of  a  palsy  or  apoplexy. 

In  a  few  extraordinary  cases  I  have  known  it 
come  on  a  little  before  the  catamenia,  and  conti- 
nue till  after  they  were  over :  in  some  females  it 


History  and  Cure  of  Biseases.       S6l 

has  seemed  to  supply  the  place  of  the  menstrual 
discharge ;  on  the  other  hand,  that  discharge  has 
proved,  as  long  as  it  continued,  an  eifectual  stop 
to  a  bleeding  of  the  nose,  in  some,  who  were  ne- 
ver free  from  it  for  so  many  days  together  at  any 
other  time. 

The  loss  of  blood  by  the  nostrils  is  perhaps  a 
symptom  of  some  internal  morbid  cause,  rather 
than  a  remedy  ;  for  it  has  not  appeared  to  me  to 
be  of  any  certain  use  in  those  distempers  with 
which  it  is  joined,  and  therefore  it  is  not  a  desira- 
ble evacuation.  But,  on  the  other  hand,  it  is  far 
from  being  a  constant  sign  of  any  great  mischief 
either  present  or  impending ;  for  1  have  known  it 
continue  in  persons  of  an  advanced  age  for  many 
years,  consistently  with  very  tolerable  health.  An 
old  head-ach  has  been  judged  to  be  relieved  by  a 
bleeding  of  the  nose  ;  but  «this  is  made  doubtful  by 
its  having  been  a  companion  in  other  cases  of 
head-achs,  and  various  disorders  of  the  head, 
without  affording  them  any  mitigation. 

Nothing  so  effectually  stops  a  profuse  bleeding 
of  this  part,  as  a  compress  put  up  the  nose,  when 
it  is  possible  to  apply  it  to  the  mouth  of  the  bleed- 
ing vessel ;  but  where  this  cannot  be  done,  I  know 
no  other  method  of  cure,  than  what  is  mentioned 
in  the  Medical  Transactions,  vol.  ii.  Query  4.^ 
In  habitual  bleedings  of  the  nose,  a  moderate  dose 
of  some  purging  salt  has  been  given  twice  or 
three  times  a  week  with  success. 

*  See  Appendix. 


262  Commentaries  on  the 

CHAPTER  65. 

Nausea,^ 

Pregnancy,  the  gout,  hard  drinking,  hypochon- 
driac disorders,  giddiness,  violent  head-achs,  a 
cough,  and  particularly  the  hooping-cough,  worms, 
a  stone  in  the  kidneys,  and  irregularities  of  the 
menstrua  :  all  these  causes,  beside  blows  on  the 
head,  and  many  fevers,  and  the  improper  quality 
or  quantity  of  the  food,  are  apt  to  disorder  the 
stomach,  and  to  bring  on  a  nauseating  and  sick- 
ness ;  which  is  sometimes  preceded  by  a  large 
quantity  of  water  filling  the  mouth.  The  morn- 
ing is  the  time  when  this  sickness  is  commonly 
greatest  (the  nerves  of  the  stomach,  like  all  the 
others,  seeming  to  be  weakest  in  the  morning ;)  it 
will  likewise  come  on  sometimes  about  three 
hours  after  dinner. 

As  this  complaint  is  owing  to  such  a  variety  of 
causes,  it  might  easily  be  expected,  as  it  is  found 
to  happen,  that  the  same  method  of  treating  it 
will  not  always  have  the  same  success.  An  eme- 
tic, lying  down,  aromatic  and  spirituous  medicines, 
a  spontaneous  or  artificial  purging,  essential  oils, 
and  opium  applied  to  the  region  of  the  stomach 
in  the  form  of  a  plaster,  or  in  the  form  of  a  lini- 
ment rubbed  over  the  abdomen,  the  juice  of  le- 
mons and  salt  of  tartar  drunk  in  the  act  of  effer- 
vescence, infusions  of  common  mint  with  or  with- 
out tincture  opii,  are  sometimes,  but  not  always 

*  See  chapter  99.  de  Vomitu. 


I 


History  and  Cure  of  Biseases.        S63 

employed  with  advantage  in  curing  a  nauseating 
fit.  Infusions  of  camomile  flowers  will  often  re- 
lieve, by  provoking  a  vomit,  or  only  by  strength- 
ening the  stomach.  In  cases  where  it  is  a  symp- 
tom dependent  upon  other  disorders,  its  cure  can 
only  be  effected  by  curing  the  principal  malady. 
Bath  waters  drunk  warm  at  the  spring  will  re- 
move several  of  the  causes  of  sickness,  and  per- 
form a  lasting  cure. 


CHAPTER  66. 

Oculorum  Morbi, 

A  WEAKNESS  will  sometimcs  attend  the  eyes, 
and  make  the  wind*  the  fire,  and  reading  very  un- 
easy to  them,  though  there  appear  no  outward 
sign  of  any  complaint.  A  greater  degree  of  weak- 
ness is  accompanied  with  wateriness,  or  gummi- 
ness,  where  the  tears  are  not  supplied  faster  than 
they  can  dry  into  such  a  consistence. 

Strumous  inflammations  of  the  eye-lids  will  long 
be  troublesome  without  much  affecting  the  eye, 
or  making  it  impatient  of  the  light  or  of  reading. 
Where  the  eye  itself  is  inflamed,  all  that  part 
which  should  be  white  will  have  its  vessels  dis- 
tended, and  be  red  with  blood  ;  it  feels  as  if  it 
were  full  of  dust  or  sand,  and  any  degree  of  light 
is  intolerable  ;  wind,  heat,  and  dust,  greatly  ag- 
gravate the  inflammation.  If  the  inflammation  ex- 
cite no  great  pain,  while  the  eyes  are  kept  dark, 
it  has  continued  for  a  year,  or  longer,  without 


264  Commentaries  on  the 

ending  in  blindness ;  though  it  will  often  leave 
films,  or  specks  upon  the  eje,  which  hurt  the 
sight  if  they  be  upon  the  cornea,  and  in  any  other 
part  are  a  defornaity.  But  dimness  of  sight,  and 
blindness,  will  sometimes  follow  long  and  violent 
inflammations.  I  have  known  the  eye  frequently 
inflamed  by  the  irritation  of  hairs  growing  in  the 
internal  part  of  the  eye-lid  and  pricking  the  eye ; 
the  plucking  out  of  these  hairs  is  the  certain  and 
only  cure. 

The  eyes  are  subject  to  excessive  and  constant 
pain  without  any  outward  appearance  of  disorder : 
this  has  been  known  to  last  for  several  days ;  and 
considerable  pain  at  the  bottom  of  the  eye  has 
continued  for  a  year  without  any  ill  consequence ; 
but  in  general  it  is  a  state  of  the  eye  much  to  be 
dreaded.  It  has  in  six-and-thirty  hours  brought 
on  a  dimness  of  sight,  which  increased  to  blind- 
ness ;  and  it  has  by  fits  been  troublesome  for  six 
years,  and  then  blindness  has  come  on. 

In  many  instances  the  sight  has  gradually  be- 
come dim,  and  at  last  been  totally  lost,  even  with- 
in the  space  of  a  few  days,  probably  from  the  op- 
tic nerves  becoming  paralytic.  I  have  seen  this 
occasioned  by  a  preternatural  mass  being  formed 
in  the  brain,  which  compressed  the  origin  of  those 
nerves.  A  giddiness  has  been  the  forerunner  of 
blindness ;  and  so  have  the  appearance  of  an  iris 
round  the  candles,  of  flashes  of  fire,  of  flies  or 
threads  floating  in  the  air,  which  are  black  in  the 
day  time  and  of  a  fiery  colour  in  the  dark,  of  co- 
lours dancing  before  the  eyes,  and  of  a  multipli- 
cation of  the  objects  :  but  at  other  times  all  these 


History  and  Cure  of  Diseases.       265 

confusions  of  vision  have  happened,  and  some  of 
them  have  continued  for  ten  jears,  yet  the  sight 
has  not  afterwards  been  hurt. 

A  blindness  will  also  come  and  go,  lasting  only 
a  few  hours,  and  this  for  several  times,  observing 
no  certain  periods ;  unlike  the  nyctalopia,  which 
returns  every  night.  The  few  blindnesses  of  this 
sort,  which  I  have  known,  have  ceased  at  last,  and 
left  the  eyes  in  their  natural  state.  A  blindness 
of  the  right  eye  has  lasted  for  fourteen  days,  and 
then  has  suddenly  passed  to  the  left,  where  it 
fixed. 

A  cataract  is  always  preceded  by  a  dimness,  or 
blue  cloudiness  of  objects,  as  if  they  were  seen 
through  gauze  ;  it  is  known  by  the  pupil  of  the 
eye,  instead  of  being  black,  becoming  coloured. 

In  affections  of  the  eyes  it  is  common  to  hear 
complaints  of  all  objects  appearing  double ;  I  re- 
member one  who  said  they  were  quadruple. 

A  gutta  serena  is  known  by  an  unusual  dilata- 
tion of  the  pupil,  and  by  its  ceasing  to  contract  or 
enlarge  according  to  the  different  degrees  of  light ; 
it  seems  to  be  a  palsy  of  the  optic  nerves.  It  is 
sometimes  confined  at  first  to  one  eye,  but  in  the 
course  of  a  few  years  is  often  extended  to  both. 
It  comes  with  so  little  pain,  and  the  sight  of  one 
eye  is  so  little  missed,  that  I  have  met  with  three 
or  four  persons,  who  by  accident  found  out  that 
one  of  their  eyes  was  dark,  of  which  in  all  proba- 
bility they  had  lost  the  sight  for  some  months  be- 
34 


so 6  Commentaries  on  the 

fore.     This  will  happen  both  in  the  gutta  serena 
and  cataract. 

There  is  a  dimness  of  sight,  in  which  dark  spots 
float  before  the  eyes,  or  only  half,  or  some  part  of 
all  objects  appear,  which  continues  for  twenty  or 
thirty  minutes,  and  then  is  succeeded  by  a  head- 
ach  lasting  for  several  hours,  and  joined  some- 
times with  sickness.  The  disagreeableness  and 
pain  of  these  paroxysms  are  very  considerable, 
biJt  as  far  as  I  have  observed,  the  danger  is  no- 
thing, though  I  have  known  some  persons  subject 
to  them  for  twenty  years.  Their  returns  seem  to 
observe  no  certain  period,  nor  have  1  even  been 
able  to  guess  at  the  immediate  occasions  of  bring- 
ing them  on,  nor  to  discover  any  remedies  either 
for  their  cure  or  relief,  except  that  lying  down 
appears  to  make  the  fit  more  tolerable,  if  not  to 
shorten  it.  It  is  less  in  summer  and  warm  cli- 
mates, and  age  seems  to  lessen  or  cure  it.  Eme- 
tics have  done  no  good  ;  it  has  even  been  suspect- 
ed that  they  rather  did  harm. 

A  violent  giddiness  has  suddenly  made  a  person 
presbyops,  or  long-sighted  ;  and  I  have  known 
two  persons,  who  after  having  been  unable  to  read 
without  the  help  of  convex  glasses  for  several 
years,  found  their  sight  come  of  itself  to  its  natu- 
ral state,  so  that  they  had  no  further  occasion  for 
spectacles.  A  giddiness  has  instantly  brought  on 
squinting,  and  made  all  objects  appear  double  for 
twenty  days,  at  the  end  of  which  the  squinting  and 
doubleness  of  objects  ceased.  The  same  thing 
happened  to  another  every  morning  just  after 
waking,  and  continued  for  some  time. 


History  and  Cure  of  Diseases.  267 

Many  are  persuaded  that  perpetual  blisters 
weaken  the  sight.  To  which  notion  we  may  be 
tempted  to  pay  very  little  regard,  when  we  consi- 
der, that  they  are  frequently  applied  with  advan- 
tage in  disorders  of  the  eyes  ;  and  further,  the  lit- 
tle probability,  which  appears  from  all  the  known 
effects  of  cantharides,  that  they  should  particular- 
ly affect  this  part ;  and  lastly  the  great  number  of 
persons,  who  keep  a  blister  for  many  years,  or 
even  a  considerable  part  of  their  lives,  without 
finding  reason  for  suspecting  any  such  mischief. 
But,  on  the  other  hand,  we  so  often  meet  with 
those,  who  are  confident  upon  repeated  trials,  that 
during  the  application  of  cantharides  their  eyes 
were  growing  weaker,  and  that  they  recovered 
upon  the  leaving  the  blisters  off,  that  we  can  diffi- 
culty account  for  the  rise  and  prevalence  of  this 
opinion,  without  its  having  some  real  foundation 
in  nature. 

Various  parts  of  the  eye  are  liable  to  ulcers  and 
cancers. 

Weak  and  watery  eyes  may  often  be  assisted 
by  taking  twice  a  week  some  purging  water,  and 
twice  every  day  a  wine  glass  of  the  decoction  or 
infusion  of  the  bark.  For  this,  and  for  some  pain- 
ful affections  of  the  eyes,  many  washes  are  recom- 
mended, as  white  vitriol,  flowers  of  zinc,  tutty, 
saccharum  Saturni,  spirit  of  wine,  or  milk  and 
water.  From  the  use  of  any  of  which  ingredients 
I  have  never  observed  any  such  certain  benefit,  as 
to  make  me  sure  that  a  wash  of  pure  water  would 
not  have  been  as  useful. 


S68  Commentaries  on  the 

Strumous  inflammations  of  the  eje-lids,  where 
the  eye  itself  is  but  little,  or  not  at  all  affected, 
do  not  require  bleeding ;  but  where  the  eyes 
themselves  are  inflamed,  nothing  can  be  done 
without  frequently  taking  away  some  blood.  Of 
all  the  ways  of  doing  which,  I  prefer  leeches  ap- 
plied to  the  temples  or  behind  the  ears,  and  it  is 
sometimes  necessary  to  have  recourse  to  them 
once  or  twice  a  week  for  several  weeks.  Cata- 
plasms of  conserve  of  roses,  or  of  the  pulp  of 
boiled  apples,  or  of  bread  and  milk,  put  between 
two  pieces  of  very  fine  lawn,  and  applied  to  the 
eyes  at  least  every  night,  and  if  the  pain  and  in- 
flammation be  considerable,  both  day  and  night, 
renewing  them  once  in  eight  hours,  are  more  ser- 
viceable than  any  collyria.  The  purging  waters, 
and  bark,  are  perhaps  the  best  internal  medicines 
both  in  this,  and  in  all  other  painful  maladies  of 
the  eyes.  It  is  useful  always  at  bed-time  to  an- 
oint the  margins  of  the  eye-lids  with  a  little  lard 
softened  with  water,  wherever  the  eye-lids  would 
otherwise  be  glued  together  in  the  morning ;  for 
if  this  be  not  prevented,  and  any  force  be  used  to 
pull  them  open,  it  wfll  not  fail  to  increase  the 
soreness  and  pain.  Setons,  issues,  and  blisters, 
will  often  be  necessary  to  assist  in  the  cure,  and 
to  prevent  the  return  of  these  diseases. 

In  a  gutta  serna  I  have  known  issues,  blisters, 
and  all  kinds  of  nervous  medicines,  strong  sneez- 
ing powders,  and  a  salivation,  used  without  any 
success.  Electrification  is  said  to  have  been  use- 
ful. 

A  cataract  admits  no  remedy,  except  that  of  the 
depression  or  extraction  of  the  crystalline  lens. 


History  and  Cure  of  Diseases.      S69 

It  is  observable  that  the  ancients  mixed  opium 
with  many  of  their  topical  medicines  for  the  eyes; 
if  we  reason  upon  any  of  its  known  powers  and 
manners  of  acting,  we  should  judge  that  as  an 
acrid  it  would  do  no  harm,  and  as  a  soporific  it 
would  do  nothing  at  all  in  this  way  of  application; 
and  probably  should  not  judge  amiss:  for  not- 
withstanding the  prepossession  in  its  favour  from 
the  authority  of  the  ancients,  this  ingredient  in 
collyria  has  sunk  into  disuse  ;  for  which  nothing 
can  account,  but  a  conviction  of  its  inefficacy  from 
repeated  trials.  Yet  by  some  late  experiments 
three  drops  of  tincture  of  opium,  applied  every 
day  to  the  eyes,  have  been  thought  useful  iq  oph- 
thalmies. 

Some  oculists  have  succeeded  in  taken  off  films 
from  the  eyes  with  a  knife,  or  with  acrid  applica- 
tions. But  this  practice  has  been  condemned  by 
many  experienced  and  judicious  surgeons,  as  too 
likely  to  excite  an  inflammation;  from  which  cause 
most  of  these  films  arise. 

Of  the  Nyctalopia,  or  Night-Blindness, 

A  MAN  about  thirty  years  old  had  in  the  spring 
a  tertian  fever,  for  which  he  took  too  small  a 
quantity  of  bark,  so  that  the  returns  of  it  were 
weakened  without  being  entirely  removed.  He 
therefore  went  into  the  cold-bath,  and  after  bath- 
ing twice  he  felt  no  more  of  his  fever.  Three 
days  after  his  last  fit,  being  then  on  board  of  a 
ship  in  the  river,  he  observed  at  sun-setting,  that 
all  objects  began  to  look  blue,  which  blueness 
gradually  thickened  into  a  cloud ;   and  not  long 


270  Commentaries  on  the 

after  he  became  so  blind,  as  hardly  to  perceive 
the  light  of  a  candle.  The  next  morning  about 
sunrising  his  sight  was  restored  as  perfectly  as 
ever.  When  the  next  night  came  on,  he  lost  his 
sight  again  in  the  same  manner;  and  this  continu- 
ed for  twelve  days  and  nights.  He  then  came 
ashore,  where  the  disorder  of  his  eyes  gradually 
abated,  and  in  three  days  was  entirely  gone.  A 
month  after,  he  went  on  board  of  another  ship, 
and  after  three  days  stay  in  it,  the  night-blindness 
returned  as  before,  and  lasted  all  the  time  of  his 
remaining  in  the  ship,  which  was  nine  nights. 
He  then  left  the  ship ;  and  his  blindness  did  not 
return  while  he  was  upon  land.  Some  little  time 
afterwards,  he  went  into  another  ship,  in  which 
he  continued  ten  days,  during  which  time,  the 
blindness  returned  only  two  nights,  and  never  af- 
terwards. 

In  the  August  following,  he  (Complained  of  loss 
of  appetite,  weakness,  shortness  of  breath,  and  a 
cough:  he  fell  away  very  fast,  had  frequent  shi- 
verings,  pains  in  his  loins,  dysury,  and  vomitings ; 
all  which  complaints  increased  upon  him  till  the 
middle  of  November,  when  he  died. 

He  had  formerly  been  employed  in  lead-works, 
and  had  twice  lost  the  use  of  his  hands,  as  is  usu- 
al among  the  workers  in  this  metal. 


History  and  Cure  of  diseases.      »7i 

CHAPTER  er. 

Osana,  or  a  Suppuration  of  the  Antrum  HighmorL 

A^  oozing  of  matter  from  the  cavity  called  an- 
trum Highmorianum  has  continued  for  many 
months.  The  frequent  injection  of  a  liquor  to 
cleanse  it,  was  the  only  help  which  it  seemed  to 
admit.  An  infusion  of  camomile  flowers  is  a  very 
proper  injection  for  this  purpose. 


CHAPTER  68. 

Palpitatio  Cordis, 

Children  sometimes  bring  with  them  into  the 
world  a  preternatural  palpitation  of  the  heart,  to- 
gether with  a  mal-conformation  of  the  breast,  or 
other  signs  of  great  unhealthiness  ;  and  it  is  found, 
at  all  times  of  life,  either  following  or  joined  with 
the  asthma,  hypochondriac  and  hysteric  com- 
plaints, the  gout,  cutaneous  diseases,  too  much  care 
and  business,  flatulence,  giddiness,  faintings,  lan- 
guor, an  urgent  and  troublesome  micturition,  and 
that  general  failure  of  the  powers  of  life  which  is 
known  by  the  name  of  a  broken  constitution.  It 
has  been  attended  with  a  perceptible  noise,  and 
rarely  fails  to  make  the  pulse  very  irregular  both 
in  time  and  strength. 

The  resemblance  which  this  disorder  bears  to 
those  complaints   that  are   called  nervous,   and 


S7S  Commentaries  on  the 

which  are  exasperated  by  bleeding,  allows  us  very 
little  hopes  of  relief  from  the  use  of  this  evacua- 
tion ;  yet  in  one  or  two  cases  I  have  known  it  tri- 
ed without  any  manifest  hurt,  and,  as  the  patient 
supposed,  with  some  benefit.  Lying  down  also 
has  in  one  person  not  increased,  but  rather  eased 
the  palpitation.  In  every  other  case,  which  I 
have  observed,  the  bed  has  constantly  aggravated 
this  uneasy  sensation,  which  has  usually  been 
worst  of  all  just  upon  waking  out  of  the  first  sleep. 
A  full  stomach  is  not  easily  borne  by  these  pa- 
tients. 

If  we  consider  the  rapid  and  irresistible  pro- 
gress of  this  complaint  from  bad  to  worse  in  some, 
and  the  very  little  disordering  of  the  health  which 
it  occasions,  together  with  the  length  of  time 
which  it  continues  in  others,  and  the  long  truces, 
during  which  it  is  wholly  suspended;  and  lastly, 
that  it  will  be  excited  in  the  healthiest  persons  by 
a  mere  thought  of  the  mind,  we  must  necessarily 
conclude  that  it  is  owing  to  a  variety  of  causes 
widely  differing  from  one  another  in  point  of  dan- 
ger. Where  it  is  curable,  and  requires  a  remedy, 
it  must  be  found  among  the  medicines  which  are 
proper  in  nervous  maladies :  but  a  palpitation  of 
the  heart  in  many  instances  arises  from  causes  too 
fatal  to  admit,  or  too  frivolous  to  stand  in  need  of 
any  cure. 


History  and  Cure  of  Diseases,        S73 

CHAPTER   69. 

Paralysis  et  Apoplexia, 

Palsies  and  apoplexies  are  only  different  de- 
grees of  the  same  distemper.  All  sudden  deaths 
are  put  down  to  the  account  ofapoplexies;  though 
some  of  them  be  unquestionably  owing  to  ruptures 
of  great  blood  vessels,  to  suffocations  from  inun- 
dations  of  phlegm,  or  from  the  breaking  of  absces- 
ses in  the  lungs,  and  other  causes  of  immediate 
death,  very  different  from  those  by  which  genu- 
ine apoplexies  are  produced.  A  sudden,  or  ra- 
pid weakness  in  some  of  the  muscles  of  voluntary 
motion,  constitutes  a  palsy,  and  in  this  manner  it 
aiost  usually  begins  ;  and  a  total  loss  of  motion  in 
every  part  of  the  body  except  the  heart  and  or- 
gans of  respiration,  together  with  insensibility,  is 
called  an  apoplexy  ;  the  cause  of  which  istsome- 
times  strong  enough  to  put  a  stop;  to  the  mption 
even  of  the  heart  and  lungs,  and  to  occasion  in- 
stant death. 

The  power  of  moving  in  every  part  of  the  body 
by  means  of  ihe  muscles  which  obey  the  will,  or 
by  means  of  others  the  actions  of  which  are  invol- 
untary ;  the  various  perceptions  by  the  live  ex- 
ternal senses ;  and  lastly,  those  mental  powers 
named  memory,  imagination,  attention,  and  judg- 
ment, together  with  the  passions  of  the  mind  ;  all 
these  seem  to  be  exercised  by  the  ministry  of  the 
nerves  :  and  are  impaired,  disturbed,  or  destroyed, 
in  proportion  to  any  injury  done  to  the  brain,  the 
spinal  marrow,,  and  nerves,  not  onlv  bv  their  pe- 

35 


^74  Commentaries  on  the 

ciiliar  diseases,  of  which  we  know  little,  but  b) 
contusions,  wounds,  ulcers,  and  distortions,  and  hj 
many  poisons  of  the  intoxicating  kind.  The  loss 
of  the  power  of  moving  is  the  obvious  and  strik- 
ing character  of  this  disease,  and  what  is  chiefly 
meant  by  the  name  of  a  palsy ;  and  it  sometimes 
happens  that  one  or  more  limbs  may  become  pa- 
ralytic, with  little  or  no  perceivable  defect  in  the 
office  of  those  nerves  on  which  the  senses  and 
operations  of  the  mind  depend.  It  is  perhaps 
more  rare,  but  by  no  means  unknown,  that  from  a 
paralytic  shock  one  or  more  of  the  external  sen- 
ses have  lost  the  exquisiteness  of  their  perception, 
or  the  mind  has  become  inattentive,  forgetful,  and 
stupid,  with  very  little  diminution  of  muscular 
strength  :  but  it  is  most  commonly  found,  that  the 
bodily  strength,  and  senses,  and  mind,  all  suffer 
from  a  considerable  stroke  of  a  palsy.  Certain 
degrees  of  a  paralytic  debility  of  the  senses  and 
intellects,  have  had  particular  names  assigned 
them,  as  carUS,  coma,  lethargy.  The  reasoning 
faculty  has  in  a  palsy  become  dull  and  wild  to 
such  a  degree  as  to  amount  to  melancholy,  idiot- 
cy,  and  madness.  Likewise  madness  and  palsy 
have  returned  alternately.  An  epilepsy  in  some 
instances  partakes  so  much  of  the  palsy  or  apo- 
plexy, that  it  is  hard  to  determine  which  symp- 
toms are  most  predominant,  and  to  which  of  these 
diseases  the  fit  most  properly  belongs.  The  same 
is  sometimes  observable  in  the  disease  called  St. 
Vitus's  dance. 

Paralytic  complaints  chiefly  attack  those  who 
are  past  the  meridian  of  life,  and  are  either  sink- 
ing into  the  infirmities  of  age,  or  are  broken  with 


I 


History  and  Cure  of  Diseases.       S75 

them  and  other  disorders.  But  the  middle  ages 
are  not  secure,  especially  where  persons  are  born 
of  paralytic  parents,  or  have  impaired  their  health 
by  fatigue,  or  intemperance.  Children  of  all 
ages  from  infancy  to  puberty  have  sometimes  lost 
the  use  of  their  limbs  without  any  other  manifest 
disposition  to  ill  health;  but  this  has  happened 
more  frequently  to  the  weakly,  and  to  those  whose 
constitutions  had  been  shattered  by  convulsive 
fits,  by  epilepsies,  and  St.  Vitus's  dance.  The 
gout  disposes  the  subjects  of  it  to  apoplexies,  eith- 
er by  a  general  debilitating  of  the  powers  of  life, 
or  by  som^  affinity  between  the  causes  of  the  two 
distempers.  There  appears  some  tendency,  though 
a  more  remote  one,  in  hypochondriac  and  hysteri- 
cal ails  to  be  aggravated  till  the  shattered  state 
of  the  nerves  become  truly  paralytic.  Chronical 
rheumatisms,  or  imperfect  gouts,  after  hanging  on 
for  many  months,  have  deadened  and  perfectly 
destroyed  all  ability  to  stir  the  limbs  affected  ;  but 
this  species  of  palsy  has  gone  no  further;  so  that 
the  senses  and  faculties  of  the  mind  have  still  con- 
tinued in  their  usual  vigour.  It  is  observable,  that 
palsies  arising  from  chronical  rheumatisms,  or  im- 
perfect gouts,  affect  chiefly  the  lower  limbs  ;  but 
those  arising  from  the  colica  Pictonum  more  usu- 
ally affect  only  the  arms  and  hands.  So  many 
women  otherwise  healthy  have  been  struck  with 
a  loss  of  their  limbs,  and  an  imperfection  of  utte- 
ranee,  and  sometimes  with  fatal  apoplexies,  in  the 
pregnant,  and  puerperal  state,  that  I  can  have  no 
doubt  of  their  being  liable  to  these  mischiefs  in 
consequence  of  these  peculiar  situations.  One 
palsy,  which  had  this  origin,  hardly  went  off  in 
two  years  ;   but  from  other  palsies  of  the  samcj 


276  Commentaries  on  the 

kind  most  women  have  entirely  recovered,  and  in 
no  long  time,  and  without  any  relapse.  The  child 
of  a  mother,  who  during  her  breeding  became  pa- 
ralytic, was  born  in  perfect  health. 

Many  palsies  of  a  small  part,  or  of  one  half  of 
the  body,  have  begun  with  an  apoplexy,  or  a  sud- 
den and  total  abolition  of  the  strength  and  senses, 
which  has  continued  from  less  than  a  minute  to 
many  hours  ;  and  the  patients  have  been  so  far 
from  having  any  previous  notice,  that  for  a  few 
hours,  or  a  few  days  before  the  fit,  they  have 
found  themselves  uncommonly  well  and  cheerful. 
But  more  palsies  have  advanced  gradually,  with- 
out the  patient's  falhng  down  in  a  motionless  and 
senseless  state  :  and  the  approach  of  some  has  not 
hindered  the  person  from  remaining  in  the  full 
possession  of  his  understanding.  A  faltering  and 
inarticulation  of  the  voice,  drowsiness,  forgetful- 
ness,  a  slight  delirium,  a  dimness  of  sight,  or  ob- 
jects appearing  double,  trembling,  a  numbness 
gradually  propagated  to  the  head,  a  frequent 
yawning,  weakness,  distortion  of  the  mouth,  a  pal- 
pitation, a  disposition  to  faint ;  some,  or  most  of 
these,  have  preceded  a  palsy  for  a  few  minutes,  or 
for  some  hours,  or  even  for  a  few  days;  and  a 
weakness  of  a  limb,  or  of  one  side,  has  been  ma- 
ny months,  or  a  few  years,  gradually  increasing 
to  a  perfect  loss  of  one  side,  or  a  hemiplegia.  I 
have  known  a  sleepiness  and  duplicity  of  objects 
with  violent  pains  and  tightness  of  the  head  for 
two  days,  then  the  senses  and  voice  were  lost,  and 
on  the  third  the  man  expired.  A  numbness  of  the 
hand  has  come  on  the  first  day,  on  the  second  a 
faltering  of  the  voice,  and  a  palsy  on  the  third. 


History  and  Cure  of  Diseases,       S77 

Similar  instances  are  very  common.  The  notices 
of  an  approaching  fit  have  come  and  gone  for  se- 
veral hours,  as  if  there  were  a  struggle  between 
the  disease  and  the  constitution,  before  these 
ihreatenings  have  either  wholly  disappeared,  or 
ended  in  a  palsy.  Violent  pains  of  the  head,  or  a 
weight,  and  tightness,  as  if  it  were  surrounded 
with  a  stiff  bandage,  giddiness,  numbnesses,  noi- 
ses in  the  ears,  and  a  frequent  bleeding  of  the 
nose  in  adults  or  old  persons,  may  probably  pro- 
ceed from  a  slight  degree  of  some  paralytic  cause ; 
but  they  have  continued  for  a  considerable  part  of 
a  man's  life  without  being  joined  by  any  other 
mischief,  and  therefore  are  by  no  means  reasons 
for  much  alarm,  though  they  may  justify  the  use 
of  some  precautions.  Flashes  of  fire,  or  dark 
spots  before  the  eyes,  have  preceded  some  apo- 
plexies, but  have  for  the  most  part  no  relation  to 
them,  being  merely  disorders  of  the  eyes,  and  not 
proceeding  from  any  general  affection  of  the 
nerves.  A  palsy  of  the  lower  limbs  has  often 
been  preceded  by  a  great  pain  in  the  loins. 

Where  the  origin  of  all  the  nerves  is  injured, 
all  their  functions  are  consequently  affected.  In 
practice  there  occur  instances  of  all  possible  va- 
rieties in  paralytic  affections  of  the  nerves,  from 
the  numbness  and  weakness  of  a  single  joint  of 
one  of  the  fingers,  to  a  total  abolition  of  sense  and 
otion  throughout  the  whole  body,  or  a  fatal 
poplexy ;  and  there  is  an  infinity  of  intermediate 
degrees  between  these  two  extremes.  The  mus- 
I  cles  of  the  lower  lip  have  been  paralytic,  and  no 
[  other  part  of  the  body.  It  is  not  very  uncommon 
^Bto  see  this  happen  to  the  muscles  of  one  or  both 


278  Comtnentaries  on  the 

the  eye-lids ;  and  a  still  more  frequent  palsy  is 
that  of  the  organs  of  speech,  taking  away  all  pow- 
er of  speaking  articulately,  or  of  speaking  at  all ; 
and  that  also  of  the  muscles  of  one  side  of  the 
face,  which  suffers  that  corner  of  the  mouth  to 
sink  lower  than  the  other,  and  hinders  the  meat 
from  being  easily  moved  about  in  mastication,  and 
sometimes  lets  the  spittle  and  drink  run  out  of  the 
mouth.  In  one  person  a  palsy  of  the  right  side 
of  the  face  was  attended  with  an  exquisite  pain 
behind  the  right  ear ;  and  in  another  a  like  pain 
behind  the  left  ear  was  joined  with  a  palsy  of 
the  left  side  of  the  face.  The  paralytic  weakness 
has  been  confined  to  the  muscles  of  deglutition, 
or  to  those  of  the  tongue.  One  arm,  one  leg,  a 
hand,  or  a  single  finger,  have  been  the  only  parts 
affected.  The  muscles  of  the  thighs  and  legs 
have  frequently  been  the  seat  of  the  distemper, 
having  lost  all  power  of  contraction,  and  so  have 
at  the  same  time  the  sphincters  of  the  bladder 
and  rectum,  so  that  the  urine  and  faeces  could  not 
be  retained  ;  in  other  instances  of  a  palsy  of  the 
lower  limbs,  these  excrements  have  been  with  dif- 
ficulty expelled,  the  muscles  serving  to  their  ex- 
pulsion having  been  more  weakened  than  the 
sphincters.  Scarcely  any  species  of  palsy  is  more 
common  than  the  hemiplegia,  in  which  the  motion 
of  one  side  is  impaired  or  lost,  from  the  forehead 
to  the  extremity  of  the  foot.  The  right  and  left 
side  are  equally  disposed  to  be  paralytic ;  at  least 
it  appeared  so  in  a  great  number  of  patients,  in 
whom  a  particular  attention  was  paid  to  this  cir- 
cumstance. The  same  paralytic  cause  seems  de- 
terminable by  slight  and  unimportant  accidents  to 
fix  upon  one  side^  rather  than  another ;  for  I  have 


Histoi^y  and  Cure  of  Diseases.     S79 

noted  eight  persons,  who  had  recovered  from  a 
hemiplegia,  and  in  a  subsequent  attack  were 
struck  on  the  opposite  side. 

Though  paralytic  persons  often  find  the  per- 
ception of  the  ^ve  senses  dull  and  confused,  yet 
1  attended  one,  whose  sense  of  smelling,  instead 
of  being  impaired,  became  so  exquisite,  as  to  fur- 
nish perpetual  occasions  of  disgust  and  uneasi- 
ness, and  from  some  very  ridiculous  causes.  A 
lethargy  in  another  patient  was  succeeded  by  a 
sleeplessness,  and  at  the  same  time  all  the  exter- 
nal senses  became  more  acute  :  but  1  do  not  re- 
member any  other  instances  of  a  palsy,  in  which 
the  functions  dependant  upon  the  nerves  (if  at  all 
affected)  were  not  altered  for  the  worse  ;  except 
that  the  appetite  has  in  some  cases  become  more 
keen.  No  symptom  is  more  common  in  this  dis- 
ease, than  a  numbness,  or  some  degree  of  a  loss 
of  feeling ;  aqd  yet  a  total  loss  of  it  is  extremely 
rare.  Out  of  the  very  great  number  of  palsies, 
which  I  have  seen,  there  have  been  only  seven  in 
which  the  sense  of  feeling  was  annihilated.  In 
three  of  these  the  feeling  was  totally  gone,  while 
some  motion  remained  ;  and  in  another  it  did  not 
return,  though  some  degree  of  motion  was  restor- 
ed. In  a  fifth  the  feeling  began  to  return  in  half 
a  year.  In  the  two  others  neither  the  feeling,  nor 
[motion,  were  ever,  as  far  as  I  knew,  retrieved.* 

Of  all  the  powers  of  the  mind,  the  memory,  and 
[the  government  of  the  passions,  appear  to  be  the 

*  RamazziDi  mentions  a  case  of  palsy  in  wblcti  one  leg  had  lost 
all  power  of  motion,  but  preserved  its  sense  of  feeling ;  and  the 
other  leg  was  deprived  of  its  feeling,  but  retained  its  motion.  D* 
Morb.  Artif.  p.  286.  E. 


S80  Commentaries  on  the 

most  weakened'  in  palsies,  though  it  may  be 
doubted  whether  they  be  more  affected  than  the 
imagination  or  judgment.  There  are  perpetual 
occasions  for  shewing  the  loss  of  memory,  and 
that  childish  impotence  of  mind,  which  suffers  a 
man  to  fall  into  tears,  or  to  be  transported  with 
joy  and  anger  for  frivolous  causes  ;  but  the  exer- 
cise of  the  imagination  and  judgment  are  more 
seldom  called  for,  and  therefore  their  usual  pow- 
ers will  not  be  so  readily  missed.  The  faculties 
of  the  mind  are  enfeebled  in  all  possible  degrees, 
as-  well  as  those  of  the  body.  When  a  person 
therefore  has  been  struck  on  the  left  side,  and 
has  at  the  same  time  lost  his  voice,  there  is  no 
certainty  of  his  being  able  to  signify  his  feelings, 
or  his  wants,  by  writing.  They,  who  have  been 
put  upon  this,  have  sometimes  been  able  to  do  it, 
though  in  a  confused  manner ;  and  the  same  per- 
son on  different  days  would  either  write  intelligi- 
bly, or  make  only  an  illegible  scrawl.  The  shock 
upon  the  understanding  has  been  such,  that  it 
was  not  possible  to  make  the  patients  mark  upon 
a  slate  yes  or  wo,  or  point  to  them  when  written, 
so  as  to  make  a  right  answer  to  any  question. 
The  inability  to  speak  is  owing  sometimes  not  to 
the  paralytic  state  of  the  organs  of  speech  only, 
but  to  the  utter  loss  of  the  knowledge  of  language, 
and  letters ;  which  some  have  quickly  regained 
and  others  have  recovered  by  slow  degrees,  get- 
ting the  use  of  the  smaller  words  first,  and  being 
frequently  unable  to  find  the  word  they  want,  and 
using  another  for  it  of  a  quite  different  meaning, 
as  if  it  were  a  language  which  they  had  once 
known,  but  by  long  disuse  had  almost  forgotten. 
After  an  apoplectic  state  for  several  days  (owing 


History  and  Cure  of  Diseases,       S81 

to  a  blow  upon  the  head)  one  person  was  forced 
to  take  some  pains  in  order  to  learn  again  to 
write,  having  lost  the  ideas  of  all  the  letters  ex- 
cept the  initials  of  his  two  names. 

A  palsied  arm  has  been  accompanied  in  many 
persons  with  an  excessive  pain  about  the  shoul- 
der, so  that  they  could  hardly  be  persuaded  that 
there  was  no  fracture  nor  dislocation.  Costive- 
ness  is  an  attendant  upon  this  distemper,  where 
the  stools  do  not  come  away  involuntarily;  but  it 
is  usually  accompanied  with  an  uncommon  flow 
of  urine.  A  paralytic  affection  of  one  side  has 
appeared,  upon  opening  the  head,  to  have  been 
occasioned  in  some  by  a  hurt,  or  some  preterna- 
tural state  of  the  brain  on  the  same  side,  and  on 
the  opposite  side  in  others. 

The  general  rule  in  a  hemiplegia  is,  that  if  the 
patient  recover,  the  motion  of  the  leg  begins  first 
to  be  gained,  and  afterwards  that  of  the  arms  ; 
but  to  this  rule  there  are  many  exceptions.  In  a 
slight  palsy  of  the  tongue,  it  has  felt  as  if  it  had 
been  scalded.  The  apoplectic  fit  rarely  goes  off 
without  leaving  some  part  paralytic  ;  however  it 
is  not  often  that  an  apoplexy  or  palsy  proves  fa- 
tal in  the  first  attack ;  but  whoever  has  suffered 
from  either  of  them,  the  same  person  is  more  live- 
ly to  be  affected  again  ;  and  the  more  frequently 
the  fits  have  returned,  the  sooner  and  more  cer- 
tainly is  a  fresh  attack  to  be  expected.  Yet  it 
has  happened,  that  persons  have  been  restored 
from  a  strong  attack  of  a  hemiplegia,  and  have 
had  no  relapse  h\  fourteen,  eighteen,  or  twenty 
years.     It  must  be  owned  indeed  that  such  cases 

36 


S8S  Commentaries  on  the 

are  rare,  and  that  a  violent  degree  of  palsy,  how 
well  soever  it  may  seem  to  have  been  cured,  sel- 
dom fails  to  be  repeated  within  the  space  of  a  few 
years,  and  it  has  frequently  returned  in  a  few 
months. 

It  is  not  uncommon  to  recover  from  a  palsy  of 
a  small  part,  as  of  one  side  of  the  face,  without 
any  ill  effects  upon  the  health  ;  and,  though  it 
happen  in  youth,  without  experiencing  an)  return 
to  extreme  old  age."  After  the  first  considerable 
shock  there  are  often  repetitions  of  smaller  fits, 
"which,  by  coming  in  the  night,  or  during  a  nap, 
are  not  observed,  but  may  be  conjectured  by  se- 
veral circumstances,  and  particularly  by  all  the 
effects  of  former  attacks  becoming  much  worse 
either  suddenly,  or  in  a  few  hours.  There  is 
particular  danger  of  these  repetitions  for  several 
days  after  a  great  fit,  till  the  constitution  have  a 
little  recovered  from  the  violence  which  it  has 
suffered  ;  and  if  the  patient  escape  these,  yet  af- 
ter a  strong:  fit  the  functions  ascribed  to  the  nerves 
are  every  day  more  and  more  enfeebled,  though 
without  any  fresh  acce&s  of  the  distemper.  The 
general  health  does  not  always  suffer  in  propor- 
tion to  the  apparent  violence  of  the  attack.  Some 
slight  fits  have  been  succeeded  by  a  great  and  ir-  • 
remediable  feebleness  both  of  body  and  mind. 
After  all  fits,  there  is  too  apt  to  be  left  some  de- 
gree of  head-ach,  giddiness,  inattention,  forgetful- 
ness,  sleepiness,  slight  delirium,  inarticulation  of 
the  voice,  hiccup,  tremblings,  weakness,  cramps, 
and  involuntary  or  causeless  laughing  and  crying. 
Among  the  many  ill  consequences  of  apoplexies  I 
have  seen  one  good  one,  and  that  was  in  an  epi- 


I 


History  and  Cure  of  Diseases.       ^83 

leptic  person,  who  never  had  any  return  of  the 
epilepsy  after  an  apoplectic  fit.  But  at  other 
times  it  has  happened,  that  an  epilepsy  first  came 
on  after  a  stroke  of  a  hemiplegia;  and  the  same 
has  been  followed  in  a  child  by  St.  Vitus's  dance. 
A  long  unsteadiness  and  trembling  of  the  right 
hand  entirely  ceased,  and  the  person,  who  had 
been  a  remarkable  penman,  was  able  to  write 
again  as  finely  as  ever,  upon  being  attacked  with 
a  palsy  of  the  left  side. 

I  know  no  certain  rule  of  judging  how  long  a 
person  may  be  struggling  with  an  apoplexy  or 
palsy,  before  he  sinks  under  them,  or  begins  to 
recover.  A  perfect  apoplectic  fit,  in  which  no 
signs  of  life  remain  beside  the  motion  of  the  heart 
and  lungs,  is  seldom  seen  unless  for  a  few  hours 
before  death.  A  less  complete  apoplexy,  but  yet 
without  any  sense,  or  voice,  or  power  of  swallow- 
ing nourishment,  has  continued  for  ten  days  be- 
fore it  proved  fatal.  A  hemiplegia  has  been  fol- 
lowed by  death  in  a  few  months,  in  a  few  days, 
or  in  a  few  hours,  and  most  commonly  by  an  apo- 
plectic fit  supervening.  But  where  a  person  has 
either  been  struck  at  first  only  with  a  hemiplegia, 
or  has  recovered  into  this  state  from  an  apoplexy, 
there  most  usually,  instead  of  growing  worse,  the 
patient  has  been  found  to  recover  from  some  of 
the  symptoms,  and  sometimes,  though  very  rare- 
ly, from  all  of  them.  The  signs  of  a  beginning 
recovery  have  sometimes  been  perceivable  in  a 
few  minutes,  and  sometimes  have  been  delayed 
for  several  days,  or  even  for  some  months,  and 
the  symptoms  have  been  gradually  retreating  for 
several  years.     A  man  of  eighty  has  recovered  in 


S84  Commentaries  on  the 

two  months.  The  use  of  the  legs  even  in  an  old 
man  has  been  regained  after  nine  months,  so  that 
he  was  able  to  walk.  In  one  heraiplegiac  the 
motion  of  the  parts  began  to  return  so  late  as  the 
end  of  the  second  year.  Two  paralytic  parox- 
ysms in  an  old  asthmatic  man  left  no  trai  es  be- 
hind them,  and  he  continued  well  for  more  than 
ten  years.  Many  who  have  been  almost  in  a 
senseless  state  wnth  a  hemiplegia,  have  been  per- 
petually at  work  with  their  sound  arm  in  shoving 
the  bed-clothes  from  their  breasts.  If  the  hemi- 
plegiacs  are  desired  to  try  if  they  can  move  the 
affected  arm,  they  all  of  them  presently  take  hold 
of  it  and  move  it  about  with  the  other  hand. 
The  most  melancholy  scene  of  this  distemper  is, 
when  it  has  kept  weakening  all  the  powers  of  the 
body  and  mind  by  very  slow  degrees,  and  letting 
loose  the  passions  almost  to  madness,  so  that  a 
man  survives  himself  for  several  years,  and  is  at 
last  reduced  to  a  most  miserable  state  (if  he  knew 
his  own  misery,)  in  which  he  is  unable  to  stand, 
to  talk,  to  feed  himself,  or  to  retain  his  urine  or 
stools,  and  yet  lives  on  in  this  helpless  condition 
for  many  months.  Those  who  are  near  their  end 
in  an  apoplexy,  very  remarkably  puff  out  both 
their  cheeks  in  every  expiration. 

It  is  probable  that  far  the  greater  part  of  pa- 
ralytic and  apoplectic  patients  would  recover 
some  degree  of  life  and  strength  by  the  unassist- 
ed efforts  of  nature  Hence  arises  a  difficulty  of 
ascertaining  the  real  efficacy  of  any  means  which 
may  have  been  used,  unless  often  repeated  trials 
should  be  found  to  have  an  uniform  effect. — 
Whenever  any  one  falls  down  in  an  apoplectic  fit, 


I 


History  and  Cure  of  Diseases.  S85 

or  is  suddenly  struck  with  a  palsy,  it  is  necessary 
in  the  first  place  to  loosen  whatever  bandage  may 
be  about  the  neck;  for  upon  the  access  of  these 
distempers  I  have  known  it  instantly  sw^ell  to  such 
a  size,  that  the  person  without  this  relief  would 
be  in  danger  of  being  strangled. 

Bleeding  is  one  of  the  first  means  usually  em- 
ployed for  the  recovery  of  an  apoplectic  person ; 
and  if  he  be  in  the  vigor  of  his  age,  or  very  ple- 
thoric, and  accustomed  to  living  in  a  full  manner, 
it  seems  a  very  fit  remedy,  and  likely  to  be  high- 
ly beneficial.  But  an  indiscriminate  use  of  large 
and  repeated  bleedings  in  all  apoplexies  and  pal- 
sies can  hardly  fail  of  being  often  attended  with 
mischief,  since  the  young  and  vigorous  are  not 
the  most  frequent  victims  of  these  maladies,  but 
rather  sickly  children,  and  the  old,  the  infirm,  and 
exhausted,  in  whom  the  vis  vitCE  wants  to  be  ex- 
cited, rather  than  lowered,  and  where  bleeding 
will  damp  every  effort  of  nature,  and  irrecovera- 
bly extinguish  the  small  remains  of  life,  as  it  is 
found  to  do  in  drowned  persons.  The  practice 
of  taking  away  blood  must  be  founded  either  in 
experience,  or  theory;  and  if  1  were  to  judge 
from  the  cases,  which  have  occurred  to  me,  I 
should  say  that  the  occasions,  where  it  could  be 
supposed  to  do  good,  have  been  extremely  few, 
and  that  large  bleedings  have  several  times  ap- 
peared to  me  to  be  prejudicial. 

Theory  may  teach,  but  will  find  some  difficulty 
in  proving,  that  apoplexies  must  arise  from  a  com- 
pression of  the  brain,  owing  either  to  a  distension 
of  the   blood-vessels,   or  to   extravasated    blood 


286  Commentaries  on  the 

from  their  rupture,  and  that  the  energies  of  the 
nerves  can  be  deadened  by  no  other  cause  beside 
fulness.  The  usual  subjects  of  palsies,  as  before 
mentioned,  do  not  favour  this  hypothesis ;  and 
the  operation  of  several  poisons  in  disturbing  or 
annihilating  the  nervous  functions  can  hardly  be 
accounted  for  by  such  a  theory  :  as  little  can  it  be 
reconciled  with  the  gradual  manner  in  which 
most  palsies,  and  many  apoplexies,  are  found  to 
advance,  and  with  the  strong  disposition  to  re- 
lapses in  those  who  have  been  emaciated  and  bro- 
ken by  many  former  fits.  Some  palsies  must  be 
owing  to  other  causes  besides  fulness;  and  what- 
ever these  causes  be,  they  may  be  the  only  ones 
of  most  palsies.  A  rupture  of  some  blood-ves- 
sels in  the  brain  may  be  the  origin  of  some  apo- 
plexies, but  probably  of  few;  because  these  can 
hardly  escape  being  instantly  fatal ;  and  we  know 
that  there  is  a  far  greater  proportion  which  do 
not  end  in  present  death.  Some  practical  authors 
tell  us  they  have  been  glad  of  finding  a  fever  in  a 
paralytic  ;  or  desirous  of  exciting  one.  This  but 
ill  accords  with  the  evacuating,  and  cooling  regi- 
men. But  I  must  own  that  I  have  no  faith  at  all 
in  this  doctrine ;  for,  according  to  all  my  experi- 
ence, the  more  fever  there  is,  the  worse  it  always 
fares  with  the  patient,  in  every  external  and  in- 
ternal ail ;  and  the  more  natural  the  pulse  is,  the 
more  hopes  there  will  be  of  a  prosperous  event. 

I  have  known  the  gout  seize  persons  ill  of  pa- 
ralytic complaints,  without  at  all  fulfilling  the  ex- 
pectations of  the  patients  and  their  friends  by  giv- 
ing them  the  least  relief;  but  this  cannot  appear 
strange  to  any  one,  who  considers  that  the  gout 


1 


b 


History  and  Cure  of  Diseases.     S87 

appears  from  experience  to  be  rather  a  cause  than 
the  remedy  of  apoplectic  diseases.  No  circum- 
stances have  encouraged  me  to  hope  for  benefit 
from  giving  any  other  emetic  than  a  little  carduus 
tea,  in  order  to  make  the  person  vomit  more  easi- 
ly, and  empty  the  stomach  more  effectually, 
where  it  was  pointed  out  by  the  sickness  and 
retching  of  the  paralytic  patient.  A  purge,  if  it 
can  be  given,  or  a  sharp  clyster,  which  may  both 
unload  and  stimulate  the  bowels,  is  alw^ays  useful; 
but  violent  purging  has  appeared  to  do  harm,  rath- 
er than  good.  Blisters  should  be  applied  as  soon 
as  possible  to  the  head,  between  the  shoulders,  and 
to  the  paralytic  limbs. 

The  medicines  proper  to  be  given,  when  the 
patient  is  sufficiently  recovered  to  be  able  to  swal- 
low, are  such  as  have  the  general  property  of 
strengthening  and  invigorating;  which  purpose  is 
well  answered  by  one  drop  of  oil  of  cloves  mixed 
with  a  little  sugar,  and  then  added  to  an  ounce 
and  a  half  of  an  infusion  of  Peruvian  bark  and  bit- 
ters, which  may  be  given  every  four  hours. 
Musk,  wild  valerian  root,  and  camphor,  are  also 
recommended  as  specifically  friendly  to  the  nerves, 
and  possessed  of  virtues,  which  revive  their  lan- 
guid motions,  and  sooth  their  irregular  ones. 
The  root  of  valerian  has  often  been  given  with- 
out much  apparent  effect ;  but  yet  I  have  met  with 
some,  whom  it  threw  into  such  agitations  and  hur- 
ries of  spirits,  as  plainly  shewed  that  it  is  by  no 
means  powerless.  Most  cats  are  fond  of  gnawing 
it,  and  seem  to  be  almost  intoxicated  by  it  into  out- 
rageous playfulness;  and  the  nerves  of  cats  afford 
a  very  tender  test  of  the  powers  which  any  sub- 


»88  Commentaries  on  the 

stances  possess  of  affecting  the  nerves.  The  pois* 
oned  darts  of  the  Indians,  tobacco,  opium,  brandj, 
and  all  the  inebriating  nervous  poisons,  are  far 
more  sensiblj  felt  by  this  animal  than  by  any 
other,  that  I  know,  of  an  equal  size. 

When  the  patient  is  judged  to  be  pretty  well 
out  of  the  reach  of  present  danger,  he  must  in 
the  next  place  be  assisted  in  freeing  himself  from 
the  several  disagreeable  reliques  of  the  former 
attack,  and  in  preventing  a  return.  For  these 
purposes  a  journey  to  Bath  is  generally  proposed  : 
about  which  physicians  seem  to  be  divided  in  their 
opinions;  some  thinking,  that  the  drinking  and  bath- 
ing at  Bath  help  to  recover  paralytics,  while  others 
are  persuaded  that  they  are  the  ready  means  of 
turning  a  palsy  into  an  apoplexy.  If  I  were  to 
judge  from  my  own  experience,  I  should  say  that 
the  Bath  waters  do  neither  good  nor  harm  to 
these  patients;  some  of  whom  gradually  recover 
while  they  stay  at  Bath ;  and  others  suffer  a  fresh 
attack  and  die  there;  just  as  they  would  in  any 
other  place.  I  therefore  cannot  advise  Bath  ;  but 
if  it  be  desired  by  the  invalids  themselves,  or  any 
of  their  friends,  there  is  no  reason  to  hinder  their 
going  thither.  There  is  not  much  more  to  be 
said  in  favour  of  the  cold  bath.  Out  of  a  great 
number  of  persons,  whom  I  have  known  to  use 
sea-bathing  for  several  successive  seasons,  and 
long  courses  of  cold  bathing  in  weakness  and  gid- 
diness; left  by  palsies,  some  have  thought  them 
prejusliciai,  and  more  have  thought  them  useful: 
but  from  all  their  accounts  1  have  concluded,  that 
cold  bathing  is  innocent,  or  in  a  small  degree  be- 
neficial.    So  that  the  chief  reason  against  advis- 


History  and  Cure  of  Diseases,       289 

ing,  or  allowing  it,  is,  that  paralytics  are  liable  to 
relapses  oT  their  disorder,  let  them  do  what  they 
will ;  and  if  any  fresh  access,  or  aggravation  of 
their  symptoms  should  happen  at  the  time  of  us- 
ing the  cold  bath,  or  soon  after,  it  would  of  course 
be  charged,  though  very  unjustly,  to  the  bathing. 

Sleep  is  the  great  restorative  after  labour,  and 
indispensably  necessary  to  life ;  yet  it  unquestion- 
ably disposes  the  body  to  be  invaded  by  all  those 
diseases  which  are  peculiarly  attributed  to  the  in- 
firm or  disordered  state  of  the  nerves,  and  among 
them  to  apoplexies  and  palsies,  many  of  which 
first  appear,  or  are  much  aggravated  during  sleep. 
In  all  these  maladies  therefore  it  behoves  those 
who  wish  to  be  restored  from  what  they  still  suf- 
fer, and  to  prevent  any  further  mischief,  to  be 
cautious  of  indulging  themselves  in  sleep,  and  to 
be  contented  with  as  moderate  a  portion  of  it,  as 
is  found  consistent  with  their  general  health. 

An  issue  should  be  made  in  the  neck,  as  soon 
as  the  blisters  are  all  healed,  and  should  be  kept 
open  during  life.  The  symptom  of  giddiness  is 
moderated  in  those  who  can  bear  this  small  loss 
of  blood,  by  taking  giway  six  ounces  by  cupping 
glasses,  more  than  by  any  other  means  :  this  has 
been  well  borne  by  those  who  could  not  bear  the 
loss  of  blood  from  a  vein  by  a  lancet.  I  have 
known  it  experienced  in  several,  and  particularly 
in  a  woman  of  sixty-eight,  who  had  such  bad  fits 
of  it,  as  made  her  several  times  fall,  and  frequent- 
ly threatened  an  apoplexy.  She  began  the  cup- 
ping at  that  time  of  life,  and  used  it  constantly 
every  six  weeks  until  she  died,  which  happened 

37 


290  Commentaries  on  the 

at  the  age  of  eighty-five.  She  was  in  no  danger 
of  ever  forgetting  it ;  for  she  felt  the  most  evident 
marks  of  wanting  this  relief,  whenever  she  de- 
ferred it  beyond  the  usual  period.  During  all 
this  time  the  giddiness  was  inconsiderable,  and 
came  but  seldom.  She  was  struck  at  last  with  a 
palsy,  which  had  probably  been  kept  off  for  ma- 
ny years  by  this  practice  of  cupping. 

When  I  knew  no  more  of  physic  than  what  I 
had  learned  from  books,  I  was  very  apprehensive, 
as  I  was  taught  to  be,  and  by  plausible  reasoning, 
that  opium  was  hurtful  in  palsies  and  apoplexies ; 
for  it  is  supposed  to  have  the  effect  of  deadening 
the  powers  of  the  nerves,  and  therefore  must  be 
improper  where  we  want  to  enliven  them.  This 
hypothesis,  however  specious,  wants  the  attesta- 
tion of  experience.  I  have  met  with  some,  who, 
while  they  were  recovering  from  a  palsy,  used 
opium  plentifully,  and  afterwards  never  passed  a 
night  without  taking  twenty  or  thirty  drops  of 
tinctura  opii  for  many  years :  which  practice  did 
not  hinder  them  from  being  very  well,  and  was 
supposed  to  assist  in  making  them  so.  In  conse- 
quence of  these  examples,  1  have  frequently  given 
it  in  paralytic  cases  where  the  restlessness  seem- 
ed to  require  it,  and  with  as  much  advantage  as 
in  any  otner  distempers.* 

The  good  success  of  electricity  in  paralytic  ma- 
ladies has  not  yet  been  sufficiently  ascertained ; 
but  it  evidently  has  some  influence  over  the  nerves. 

*  M.  Chapelain,  medecin  de  Montpellier,  avoit  gu^ri  un  bomme 
eo  apoplexie  par  un  grain  de  laudanum.— ^cad.  Roi/.  des  ScienA 
1703,  Hist.  p.  57. 


History  and  Cure  of  Diseases,     S91 

An  intermittent  fever  has  more  than  once,  during 
the  fit,  been  attended  with  paralytic  symptoms ; 
but  these  have  all  yielded,  together  with  the  fe- 
ver, to  the  Peruvian  bark. 


A  Case  of  Catalepsy, 

26th  June  1764,  in  St.  Thomas's  hospital,  I  saw 
a  woman  six-and-thirty  years  of  age  motionless 
with  a  fit  of  the  catalepsy.  Her  pulse  was  quite 
natural ;  her  breathing  easy.  Her  eyes  were  fix- 
ed, as  by  attentive  contemplation,  not  like  those 
of  a  person  who  is  either  dying,  or  sick,  or  under 
any  pain  or  uneasiness.  Her  limbs  all  retained 
the  situation  in  which  they  were  placed  by  the 
bystanders,  however  inconvenient.  I  extended 
her  arm,  and  saw  it  remain  stretched  out  for 
twenty  minutes ;  and  I  was  told  it  continued  soon 
a  former  trial  above  an  hour,  which  scarcely  any 
body  in  health  could  support.  1  heard  even  that 
it  would  remain  extended  with  a  weight  of  seven 
pounds  in  the  hand.  If  the  patient  was  placed 
upright,  she  continued  upright,  and  was  not  very 
easily  thrown  down.  While  she  was  sitting 
down,  both  the  legs  were  extended,  and  raised 
from  the  ground  ;  and  they  remained  in  that  un- 
easy posture,  as  if  they  had  been  made  of  clay,  or 
of  wax.  Her  mouth  was  closed,  and  1  was  una- 
"ble  by  any  means  to  open  it.  The  eye-lids  wert^ 
constantly  open  ;  or  if  forcibly  closed,  they  open- 
ed again  as  soon  as  the  force  was  removed.  She 
winked,  but  in  a  very  slight  manner,  upon  moving 
the  finger  quick  towards  the  eye  ;  at  other  times 
the  eye-lids  did  not  move.     At  the  approach  of  e* 


S9S  Commentaries  on  the 

candle  the  pupil  contracted.  If  the  nostrils  were 
compressed,  after  a  little  effort,  and  apparent 
struggle,  the  lips  opened  for  the  purpose  of 
breathing.  I  heard  that  she  had  been  in  this 
state  some  months.  The  fits  returned  morning 
and  evening  almost  every  day,  and  continued 
sometimes  an  hour,  at  other  times  three  hours. 
The  nurse  reported  that  one  fit  had  lasted  twelve 
hours.  She  used  to  be  suddenly  seized,  without 
any  previous  notice. 


CHAPTER  ro. 

Pectoris  Dolor. 

Beside  the  asthma,  hysteric  oppressions,  the 
acute  darting  pains  in  pleurisies,  and  the  chroni- 
cal ones  in  consumptions,  the  breast  is  often  the 
seat  of  pains,  which  are  distressing,  sometimes 
even  from  their  vehemence,  oftener  from  their 
duration,  as  they  have  continued  to  teaze  the  pa- 
tient for  six,  for  eight,  for  nine,  and  for  fourieen 
years.  There  have  been  several  examples  of 
their  returning  periodically  every  night,  or  alter- 
nately with  a  head-ach.  They  have  been  called 
fouty,  and  rheumatic,  and  spasmodic.  Tiiere 
as  appeared  no  reason  to  judge  that  they  pro- 
ceed from  any  cause  of  much  importance  to  health 
(being  attended  with  no  fever,)  or  that  they  lead 
to  any  dangerous  consequences  ;  and  if  the  pjalient 
were  not  uneasy  with  what  he  feels,  he  needs  ne- 
ver to  be  so  on  account  of  any  thing  which  he  has 
tp  fear. 


History  and  Cure  of  Diseases.        S93 

If  these  pains  should  return  at  night,  and  dis- 
turb the  sleep,  small  doses  of  opium  have  been 
found  serviceable,  and  may  be  used  alone,  or 
joined  with  an  opening  medicine,  with  a  prepara- 
tion of  antimony,  or  with  the  fetid  gums.  Exter- 
nally, a  small  perpetual  blister  applied  to  the 
breast  has  been  succeessful,  and  so  has  an  issue 
made  in  the  thigh.  A  large  cumin  plaster  has 
been  worn  over  the  seat  of  the  pain  with  advan- 
tage. The  volatile,  or  saponaceous  liniment, 
may  be  rubbed  in  over  the  part  aflfected.  Bath- 
ing in  the  sea,  or  in  any  cold  water,  may  be  used 
at  the  same  time. 

But  there  is  a  disorder  of  the  breast  marked 
with  strong  and  peculiar  symptoms,  considerable 
for  the  kind  of  danger  belonging  to  it,  and  not 
extremely  rare,  which  deserves  to  be  mentioned 
more  at  length.  The  seat  of  it,  and  sense  of 
strangling,  and  anxiety  with  which  it  is  attended, 
may  make  it  not  improperly  be  called  angina  pec- 
toris. 

They  who  are  afflicted  with  it,  are  seized  while 
they  are  walking,  (more  especially  if  it  be  up  hill, 
and  soon  after  eating)  with  a  painful  and  most 
disagreeable  sensation  in  the  breast,  which  seems 
as  if  it  would  extinguish  life,  if  it  were  to  increase 
or  to  continue ;  but  the  moment  they  stand  still, 
all  this  uneasiness  vanishes. 

In  all  other  respects,  the  patients  are,  at  the 
beginning  of  this  disorder,  perfectly  well,  and  in 
particular  have  no  shortness  of  breath,  from  which 
it  is  totally  different.     The  pain  is  sometimes  si- 


294  ComnientaHes  on  the 

tuated  in  the  upper  part,  sometimes  in  the  mid- 
dle, sometimes  at  the  bottom  of  the  os  sterni,  and 
often  more  inclined  to  the  left  than  to  the  right 
side.  It  likewise  very  frequently  extends  from 
the  breast  to  the  middle  of  the  left  arm.  The 
pulse  is,  at  least  sometimes,  not  disturbed  by  this 
pain,  as  I  have  had  opportunities  of  observing  by 
feeling  the  pulse  during  the  paroxysm.  Males 
are  most  liable  to  this  disease,  especially  such  as 
have  past  their  fiftieth  year. 

After  it  has  continued  a  year  or  more,  it  will 
not  cease  so  instantaneously  upon  standing  still ; 
and  it  will  come  on  not  only  when  the  persons  are 
walking,  but  when  they  are  lying  down,  especial- 
ly if  they  lie  on  the  left  side,  and  oblige  them  to 
rise  up  out  of  their  beds.  In  some  inveterate 
cases  it  has  been  brought  on  by  the  motion  of  a 
horse  or  a  carriage,  and  even  by  swallowing, 
coughing,  going  to  stool,  or  speaking,  or  any  dis- 
turbance of  mind. 

Such  is  the  most  usual  appearance  of  this  dis- 
ease ;  but  some  varieties  may  be  met  with.  Some 
have  been  seized  while  they  were  standing  still, 
or  sitting,  also  upon  first  waking  out  of  sleep : 
and  the  pain  sometimes  reaches  to  the  right  arm, 
as  well  as  to  the  left,  and  even  down  to  the  hands, 
but  this  is  uncommon  :  in  a  very  few  instances  the 
arm  has  at  the  same  time  been  numbed  and  swell- 
ed. In  one  or  two  persons  the  pain  has  lasted 
some  hours,  or  even  days  ;  but  this  has  happened 
when  the  complaint  has  been  of  long  standing, 
and  thoroughly  rooted  in  the  constitution :  once 


Histoid  and  Cure  of  Diseases,       S95 

only   the  very  first  attack  continued   the   whole 
night. 

I  have  seen  nearly  a  hundred  people  under.this 
disorder,  of  which  number  there  have  been  three 
women,  and  one  boy  twelve  years  old.  All  the 
rest  were  men  near,  or  past  the  fiftieth  year  of 
their  age. 

Persons  who  have  persevered  in  walking  till 
the  pain  has  returned  fi^ur  or  five  times,  have  then 
sometimes  vomited. 

A  man  in  the  sixtieth  year  of  his  life  began  to 
fee!,  while  he  was  walkmg,  an  uneasy  sensation 
in  his  left  arm.  He  qever  perceived  it  while  he 
was  travelling  in  a  carriage.  After  it  had  conti- 
nued ten  years,  it  would  come  upon  him  two  or 
three  times  a  week  at  night,  while  he  was  in  bed, 
and  then  he  was  obliged  to  sit  up  for  an  hour  or 
two  before  it  would  abate  so  much  as  to  suffer 
him  to  lie  down.  In  all  other  respects  he  was 
very  healthy,  and  had  always  been  a  remarkably 
strong  man.  The  breast  was  never  affected. 
This  disorder,  its  seat  excepted,  perfectly  resem- 
bled the  angina  pectoris,  gradually  increasing  in 
the  same  manner,  and  being  both  excited  and  re- 
lieved by  all  the  same  causes.  He  died  suddenly 
without  a  groan  at  the  age  of  seventy-five. 

The  termination  of  the  angina  pectoris  is  re- 
markable. For  if  no  accident  intervene,  but  the 
disease  go  on  to  its  height,  the  patients  all  sud~ 
denly  fall  down,  and  perish  almost  immediately. 
Of  which  indeed  their  frequent  faintnesses,  and 


296  (Commentaries  on  the 

sensations  as  if  all  the  powers  of  life  were  failing, 
afford  no  obsure  intimation. 

The  angina  pectoris,  as  far  as  1  have  been  able 
to  investigate,  belongs  to  the  class  of  spasmodic, 
not  of  inflammatory  complaints.     For, 

In  the  1st  place^  the  access  and  the  recess  of 
the  fit  is  sudden. 

2dly,  There  are  long  intervals  of  perfect  health. 

3dly,  Wine,  and  spirituous  liquors,  and  opium, 
afford  considerable  relief. 

4thlj,  It  is  increased  by  disturbance  of  the 
mind. 

5thly,  It  continues  many  years  without  any 
other  injury  to  the  health. 

6thly,  In  the  beginning  it  is  not  brought  on  by 
riding  on  horseback,  or  in  a  carriage,  as  is  usual 
in  diseases  arising  from  scirrhus,  or  inflammation. 

7thly,  During  the  fit  the  pulse  is  not  quicken- 
ed. 

Lastly,  Its  attacks  are  often  after  the  first 
sleep,  which  is  a  circumstance  common  to  many 
spasmodic  disorders. 

Yet  it  is  not  to  be  denied  that  I  have  met  with 
one  or  two  patients,  who  have  told  me  they  now 
and  then  spit  up  matter  and  blood,  and  that  it 


History  and  Cure  of  Diseases.       297 

seemed  to  them  to  come  from  the  seat  of  the  dis- 
ease. In  another,  who  fell  down  dead  without 
any  notice,  there  immediately  arose  such  an  offen- 
sive smell,  as  made  all  who  were  present  judged 
that  some  foul  abscess  had  just  then  broken. 

On  opening  the  body  of  one,  who  died  sudden- 
ly of  this  disease,  a  very  skilful  anatomist  could 
discover  no  fault  in  the  heart,  in  the  valves,  in  the 
arteries,  or  neighbouring  veins,  excepting  some 
small  rudiments  of  ossification  in  the  aorta.  The 
brain  was  likewise  every  where  sound.  In  this 
person,  as  it  has  happened  to  others  who  have  di- 
ed by  the  same  disease,  the  blood  continued  fluid 
two  or  three  days  after  death,  not  dividing  itself 
into  crassamentum  and  serum,  but  thick,  like 
cream.  Hence  when  a  vein  has  been  opened  a 
little  before  death,  or  perhaps  soon  after,  the 
blood  has  continued  to  ooze  out  as  long  as  the 
body  remained  unburied. 

With  respect  to  the  treatment  of  this  complaint, 
I  have  little  or  nothint;  to  advance  :  nor  indeed  is 
it  to  be  expected  we  should  have  made  much  pro- 
gress in  the  cure  of  a  disease,  which  has  hitherto 
hardly  had  a  place  or  a  name  in  medical  books.* 

*  Cceliiis  Aurelianus,  as  far  as  I  know,  is  the  only  ancient  writer 
who  has  noticed  this  complaint,  and  he  but  slightly  :  "  Erasistra- 
"  tus  moraorat  paralyseos  genus,  et  paradoxon  appellat,  quo  ambu- 
*'  lantes  repente  sistuntur,  ut  ambuiare  non  possint,  et  turn  rursum 
'' ainbulare  sinuntur."  Chron.  lib.  ii.  c.  1. — 31  Saussnre  in  his 
Voyage  dans  leu  Alyes  says,  that  at  the  height  of  13  or  1400  toises 
above  the  sea,  a  peculiar  tiredness  often  comes  upon  those  who  are 
ascending  such  high  hills,  so  that  it  is  impossible  to  proceed  four 
steps  further  ;  and  if  it  were  attempted,  such  strong  universal  pal- 
pitations would  come  on,  as  could  not  fail  to  end  in  swooning. 
I  pon  resting  three  minutes,  even  without  sitting  down,  this  tired- 

38 


^98  Commentaries  on  the 

Quiet,  and  warmth,  and  spirituous  liquors,  help 
to  restore  patients  who  are  nearly  exhausted,  and 
to  dispel  the  effects  of  a  fit  when  it  does  not  soon 
go  off.  Opium  taken  at  bed-time  will  prevent 
the  attacks  at  night.  I  knew  one  who  set  him- 
self a  task  of  sawing  wood  for  half  an  hour  every 
day,  and  was  nearly  cured.  In  one  also  the  dis- 
order ceased  of  itself  Bleeding,  vomiting,  and 
purging,  appear  to  me  to  be  improper. 


CHAPTER  n. 

Pedicularis  Morbus. 

1762.  Aug.  23.  I  was  this  day  informed  by 
Sir  Edward  Wilmot,  that  he  had  seen  a  man  who 
was  afflicted  with  the  morbus  pedicularis.  Small 
tumours  were  dispersed  over  the  skin,  in  which 
there  was  a  very  perceptible  motion,  and  a  vio- 
lent itching.  Upon  being  opened  with  a  needle 
they  were  found  to  contain  insects  in  every  re- 
spect resembling  common  lice,  excepting  that 
they  were  whiter.  Sir  Edward  Wilmot  ordered 
a  wash,  consisting  of  four  ounces  of  spirits  of 
wine,  four  ounces  of  rectified  oil  of  turpentine, 
and  six  drams  of  camphor.  The  day  following 
he  told  me  all  the  insects  had  been  killed  on  be- 
ing touched  with  this  liquor,  and  that  all  the  itch- 
ing had  immediately  ceased. 

ness  passes,  and  the  power  of  going  on  is  perfectly  restored.  Tlir 
clinabing  of  steep  hills,  which  are  not  so  high  above  the  sea,  does 
not  occasion  this  pecuUar  fatigue.     Vol.  i.  p.  482. 


History  and  Cure  of  Biseases.     S99 


CHAPTER    72. 

Phthisis  Pulmonum, 

A  CONSUMPTION  appears  by  the  London  bills  of 
mortality  to  be  in  that  city  the  most  destructive 
of  all  maladies  to  adults ;  one  in  four  of  those 
that  grow  up  to  manhood  being  reported  to  be 
carried  off  by  this  distemper.  But  all  these  must 
not  be  charged  to  the  account  of  a  pulmonary 
consumption  ;  because  whoever  decline  and  waste 
away  by  any  obscure,  unnamed  distemper,  are 
all  charged  to  this  article,  though  the  lungs  be 
not  at  all  diseased. 

The  phthisis  pulmonum  usually  begins  with  a 
dry  cough,  so  slight  and  inconsiderable,  that  little 
or  no  notice  is  taken  of  it,  till  its  continuance,  and 
gradual  increase,  begin  to  make  it  regarded. 
Such  a  cough  has  lasted  for  a  few  years  without 
bringing  on  other  complaints.  It  has  sometimes 
wholly  ceased,  and  after  a  truce  of  a  very  uncer- 
tain length  it  has  returned,  and  after  frequent  re- 
coveries and  relapses,  the  patient  begins  at  last  to 
find  an  accession  of  other  symptoms,  which  in  bad 
cases  will  very  soon  follow  the  appearance  of  the 
first  cough.  These  are  shortness  of  breath, 
hoarseness,  loss  of  appetite,  wasting  of  the  flesh 
and  strength,  pains  in  the  breast,  profuse  sweats 
during  sleep,  spitting  of  blood  and  matter,  shiver- 
ings  succeeded  by  hot  fits,  with  flushings  of  the 
face,  and  burning  of  the  hands  and  feet,  and  a 
pulse  constantly  above  ninety,  a  swelling  of  the 
legs,  and  an  obstruction  of  the  menstrua  in  wo- 


300  Commentaries  on  the 

men;  a  very  small  stone  has  sometimes  been 
coughed  up,  and  in  the  last  stages  of  this  illness  a 
diarrhoea  helps  to  waste  the  little  remainder  of 
flesh  and  strength. 

A  spitting  of  blood  has  sometimes  been  the  first 
symptom  ;  but  while  it  is  found  alone,  it  is  but  a 
slender  proof  of  an  imminent  consumption,  even 
when  the  blood  certainly  flows  from  the  lungs  ; 
and  many  have   been   unnecessarily  alarmed    by 
the  appearance  of  what  came  only  from  their  nos- 
trils, gums,  or  throat.*     But   this,  when  united 
with  other  symptoms,  is  of  great  importance  in 
determining  the  true  seat  ot  the  distemper.     The 
spitting  of  matter  would  at  least  be  as  certain  a 
proof,  if  we  had  any  infallible  signs  by  which  to 
distinguish  the  matter  of  an  ulcer  from  the  mere 
exudation  of  an  inflamed  membrane ;  but  all  the 
criteria   mentioned   in   books   are   insufficient   for 
this  purpose ;  and  I  have  known  some  attentive 
and  very  experienced  physicians  mistaken  in  their 
judgment  upon  this  point.     All  the  other  symp- 
toms of  a  pulmonary  consumption,  except  bloody 
and   purulent   spitting,   I   have   observed   in  one, 
whose  mesenteric  glands  after  death  were  found 
to   be   scirrhous,   but   whose   lungs   were   sound. 
However,  this  happens  so  very  seldom,  that  very 
little  doubt  is  to  be  made  of  the  diseased  state  of 
the  lungs,  where  all  the  other  symptoms  concur, 
though  these  two  should  be  wanting. 

A  shortness  of  breath,  and  a  quick  pulse,  are 
the    two    most   dangerous    signs  in   a  suspected 

*  See  chapter  84,  on  spitting  of  blood. 


History  and  Cure  of  Diseases.       301 

phthisis.  I  have  known  a  person  die  of  a  con- 
sumption, whose  lungs  upon  dissection  were  found 
in  a  nfjost  diseased  state,  and  yet  during  the  wljole 
illness  there  was  no  spitting  of  blood,  no  pain  of 
the  breast,  nor  any  difficulty  in  lying  upon  either 
side. 

A  consumption  is  a  distemper  of  that  kind, 
which  is  most  certainly  derived  from  the  parents, 
and  yet  rarely  makes  its  appearance  before  pu- 
berty ;  between  which  and  the  age  of  thirty  is  the 
time  of  the  greatest  danger.  Some  have  been  at- 
tacked at  forty,  and  have  died  after  struggling 
with  it  four  or  five  years.  Others  have  been  af- 
flicted with  a  cough  every  winter  for  twenty 
years,  or  more,  who  so  late  in  life  as  at  the  age 
of  fifty  have  had  all  the  other  phthisical  symptoms 
come  on  very  hastily,  and  have  died  truly  con- 
sumptive. The  more  common  event  of  such  a 
long  cough  has  been  to  degenerate  in  the  decline 
of  life  into  an  asthma.  Some  violent  causes,  such 
as  the  measles,  hooping-cough,  or  peripneumony, 
may  make  the  latent  seeds  of  a  pulmonary  con- 
sumption begin  to  appear,  or  may  form  this  dis- 
temper, even  in  childhood,  or  decrepit  age,  of 
which  there  have  been  too  many  examples. 

■  The  persons  most  subject  to  a  pulmonary 
phthisis  are  those  who  are  born  of  consumptive 
parents,  and  those  in  whom,  during  their  infancy, 
or  childhood,  the  mesenteric  glands,  or  the  lym- 
phatic glands  of  the  neck  and  jaw  were  swelled, 
and  scirrhous,  and  especially  if  they  have  suppu- 
rated. We  are  too  little  acquainted  with  the  ani- 
mal economy    to  account  lor  this  disposition  of 


302  Commentaries  on  the 

these  glands  to  swell  in  the  earliest  part  of  life, 
and  that  of  those  in  the  lungs  to  be  affected  in 
youth  and  manhood  ;  while  it  is  more  usually  af- 
ter the  meridian  of  life,  that  the  glands  in  the 
breast  of  women  and  in  the  womb  begin  to  be  dis- 
eased, and  likewise  the  prostate  gland  in  men, 
and  those  of  the  stomach,  intestines,  and  other  ab- 
dominal viscera  in  both  sexes.  In  women  of  con- 
sumptive habits  the  state  of  pregnancy  seems  to 
hasten  the  appearance  of  the  cough,  and  of  all 
the  other  symptoms  :  the  distemper  makes  a  rapid 
progress  at  this  time,  and  yet  the  patients  often 
hold  out  beyond  expectation  till  they  are  brought 
to  bed,  and  not  long  after. 

The  state  of  the  pulse  is  of  great  importance 
in  acquainting  us  with  the  degree  of  danger  in  a 
cough,  which,  on  account  of  its  duration,  and  of 
the  bad  symptoms  with  which  it  is  accompanied, 
begins  to  be  of  a  suspicious  nature.  A  young 
man  of  eighteen,  together  with  a  cough,  had  a 
spitting  of  blood,  a  shortness  of  breath,  vomiting, 
pains  in  the  side,  night  sweats,  and  was  much 
wasted  for  two  years  ;  but  with  these  complaints 
his  pulse  was  hardly  quit;ker  than  it  should  be, 
and  in  three  years  he  had  perfectly  recovered 
his  health.  Nor  is  this  the  only  instance  of  the 
kjr.d,  of  which  I  have  been  a  witness.  I  impute 
the  cure  not  to  any  medicine,  but  rather  to  the 
patient's  constitution,  which  was  neither  scrofu- 
lous, nor  derived  from  consumptive  parents ;  and 
therefore  the  hurt  done  to  his  lungs  bj  a  violent 
cold,  which  he  had  catched,  might  be  considered 
in  the  same  light  with  a  wound  made  in  the  lungs 
of  a  healthy  man ;  which,  though  it  be  attended 


History  and  Cure  of  Diseases.  308 

with  many  consumptive  symptoms,  yet  we  know 
by  experience  may  be  healed,  and  the  health  re- 
stored. Something  of  the  same  kind  is  observa- 
ble in  peripneumonies,  from  which  after  great  in- 
flammation, and  cough,  and  spitting  of  blood,  ma- 
ny have  perfectly  recovered. 

In  England  we  have  very  little  apprehension 
of  the  contagious  nature  of  consumptions ;  of 
which  in  other  countries  they  are  fully  persuaded. 
I  have  not  seen  proof  enough  to  say  that  the 
breath  of  a  consumptive  person  is  infectious;  and 
yet  I  have  seen  too  much  appearance  of  it,  to  be 
sure  that  it  is  not;  for  I  have  observed  several  die 
of  consumptions,  in  whom  infection  seemed  to  be 
the  most  probable  origin  of  their  illness,  from 
their  having  been  the  constant  companions,  or 
bed-fellows,  of  consumptive  persons. 

Our  great  experience  of  this  distemper  has  hith- 
erto availed  but  little  in  enabling  us  to  find  out 
an  effectual  remedy.  The  cure  o(  a  disease  inhe- 
rited from  parents,  or  owing  to  such  a  vitiated 
habit  of  body,  as  that,  which  is  called  scrofulous, 
has  proved  at  least  as  difficult  as  it  might  have 
been  expected,  and  physicians  have  hardly  ad- 
vanced farther  towards  it,  than  by  being  able  to 
mitigate  some  of  the  symptoms.  Asses  milk  puts 
some  check  upon  the  tendency  to  emaciate.  The 
dilute  acid  of  vitriol  in  a  decoction  of  bark  is  a 
very  effectual  remedy  of  the  night  sweats,  and,  as 
far  as  1  have  seen,  is  perfectly  safe  in  all  stages  of 
this  malady.  A  shortness  of  breath  is  no  reason 
against  using  either  this  medicine,  or  an  opiate  at 
bed-time,  which  is  the  most  certain  soother  of  the 


304  Commentaries  on  the 

cough,  and  saves  the  patient  from  being  harassed 
with  a  restless  night  after  a  wearisome  day. 
Where  the  pain  of  the  side  is  violent,  it  will  re- 
quire, and  is  generally  relieved  by  taking  away 
four  or  five  ounces  of  blood.  If  this  pain  be  ra- 
ther lingering  and  teazing,  than  violent,  a  small 
blister  applied  to  the  part  rarely  fails  of  making  a 
cure.  A  diarrhoea  has  seldom  resisted  three  or 
four  drops  of  tinctura  opii  taken  after  every  stool. 
No  medicines  need  be  directed  for  the  hoarseness, 
swelling  of  the  legs,  or  obstruction  of  the  men- 
strua, which  necessarily  belong  to  the  disease  of 
the  lungs  and  windpipe,  and  to  the  weak,  exhaust- 
ed state  of  the  patient,  and  are  no  otherwise  to  be 
cured,  than  by  curing  the  principal  distemper. 
The  fever  and  the  signs  of  inflammation  may  rise 
so  high,  as  to  justify  the  losing  a  little  blood ;  but 
frequent  bleedings,  though  small,  have  appeared 
to  injure  the  patient,  by  conspiring  with  the  dis- 
temper to  rob  him  of  his  flesh  and  strength. 

Dissections  of  those  who  have  died  of  pulmona- 
ry consumptions,  have  acquainted  me,  that  their 
lungs  are  full  of  little  glandular  swellings,  many 
of  which  are  in  a  state  of  suppuration.  They  ap- 
pear to  be  of  the  same  nature  as  the  strumous 
swellings  in  the  neck,  but  must  always  be  more 
dangeroub,  because  the  texture  of  the  lungs  dis- 
poses them  to  spread,  and  because  the  office  of 
the  lungs  is  necessary  to  life,  so  that  they  cannot 
be  greatly  injured  without  the  worst  effects  upon 
the  health. 

Many  medicines  have  been  delivered  down  from 
former  physicians,  as  remedies  in  strumous  dis- 


History  and  Cure  of  Diseases.        305 

eases;  the  efficacy  of  all  which  have  upon  trial 
appeared  so  dubious,  that  I  cannot  from  experi- 
ence recommend  any  of  them  as  hkely  to  correct 
the  strumous  habit,  or  to  disperse  the  glandular 
swelhngs  of  the  lungs  which  have  not  yet  suppu- 
rated, or  to  heal  those  which  are  already  ulcered, 
or  to  prevent  any  more  from  becoming  scirrhous. 
In  this  case  therefore,  as  in  all  others  where  the 
proper  remedies  have  not  yet  been  discovered, 
the  patient  must  be  contented  with  instructions, 
which  may  enable  him  to  avoid  what  has  been 
found  to  aggravate  the  distemper,  and  by  a  pro- 
per regimen  to  put  the  general  health  into  the 
best  possible  state ;  that  the  natural  powers  im- 
planted in  the  body  of  readjusting  any  disordered 
part,  may  be  able  to  exert  themselves  with  the 
greatest  vigor:  nor  needs  the  patient  to  despair 
of  success  from  this  care  and  attention.  The 
breasts  of  women  seem  to  be  as  full  of  glands, 
and  of  as  lax  a  texture  as  the  lungs;  yet  1  have 
sometimes  seen  scirrhous  knots  in  them  of  a  very 
alarming  appearance,  which  have  dispersed,  or 
become  indolent,  so  that  a  final  stop  was  put  to 
any  further  mischief,  merely  by  a  proper  diet  and 
the  strength  of  their  constitution. 

That  something  of  this  kind  may  happen  in  re- 
gard to  the  lungs  is  probable  ;  for  some,  who  in 
their  youth  have  had  symptoms  of  a  consumption 
in  great  number,  and  in  no  inconsiderable  degree, 
have  recovered  and  reached  old  age  without  any 
relapse.  This  was  the  case  with  that  very  inge- 
nious and  learned  physician  Sir  Edward  Wilnjot, 
who,  as  he  told  me,  when  he  was  a  youth,  was  so 
far  gone  in  a  consumption,  that  the  celebrated  Dr. 

39 


306  Commentaries  on  the 

Radcliffe,  whom  he  consulted,  gave  his  friends  no 
hope  of  his  recovery  :  yet  he  Hved  to  be  above 
ninety  years  old.  A  youth  of  sixteen,  after  hav- 
ing the  usual  signs  of  a  phthisis  for  many  months, 
and  being  apparently  in  the  last  stage  of  it,  vi^as 
almost  suffocated  by  bringing  up  at  once  a  great 
quantity  of  matter,  and,  after  a  few  days,  the  bag, 
in  which  it  had  probably  been  contained.  He 
soon  recovered  his  flesh  and  strength,  became  a 
strong  man,  and  lived  to  old  age,  with  a  family  of 
robust  children  and  grandchildren ;  yet  he  was 
remarkably  subject  to  a  cough  upon  every  slight 
cold,  and  had  returns  of  spitting  of  blood  several 
times  every  year. 

It  is  common  to  have  very  bad  consumptive 
symptoms  abate,  and  keep  quiet  for  a  whole  sum- 
mer, or  for  a  few  years,  and  then  after  some  se- 
vere weather,  or  intemperance,  or  catching  cold, 
to  return,  and  end  fatally.  Now,  whatever  has 
checked  the  distemper  for  a  year  or  two,  might 
possibly  have  kept  it  under  till  old  age.  Agreea- 
bly to  this  supposition,  I  have  known  an  heredi- 
tary consumption  at  the  age  of  twenty-nine  cured 
after  removal  into  a  warm  climate,  without  any 
relapse  for  twenty  years ;  and  1  know  not  that  it 
ever  returned.  An  ample  provision  has  been 
kindly  made,  sometimes  by  duplicates,  of  several 
parts  of  the  body  which  are  indispensably  useful 
to  life,  that  in  case  one  of  them,  or  some  part 
should  fail,  there  may  still  be  enough  remaining 
to  answer  their  purpose  in  a  tolerable  manner. 
The  lungs  afford  an  example  of  this ;  for  in  bo- 
dies, which  have  been  opened,  one  lobe  has  some- 
times been  almost  annihilated,  and  so  much  of  the 


History  and  Cure  of  Diseases.       307 

other  destroyed,  as  to  make  it  probable,  that  not 
only  life,  but  even  tolerable  health  might  be  car- 
ried on  after  the  strumous  swellings  had  made 
great  ravages  in  the  lungs,  if  we  had  but  the 
means  of  stopping  the  mischief  here,  and  of  effec- 
tually hindering  it  from  going  any  further.  This 
is  confirmed  by  what  is  seen  in  pocky  consump- 
tions, from  which,  by  means  of  the  specific  anti- 
dote, many  have  been  restored  to  health  after 
great  injury  done  to  the  lungs.  Hereafter  we 
hope  there  may  be  found  out  as  certain  a  remedy 
for  the  strumous  virus.  In  the  mean  time  the 
consumptive  patient  does  not  want  encourage- 
ment to  persevere  steadily  in  a  strict  regimen,  and 
a  solicitous  shunning  of  whatever  may  weaken 
the  natural  strength,  or  aggravate  the  distemper. 

Cold  weather,  and  bleak  winds,  will  occasion 
coughs  in  the  soundest  lungs,  and  cannot  be  too 
carefully  avoided,  where  they  are  morbidly  ten- 
der. Warm  covering,  as  a  flannel  waistcoat,  will 
have  its  use ;  but  where  a  removal  to  a  warm  cli- 
mate is  not  impracticable,  this  will  prove  the  most 
successful  means.  An  island  without  any  very 
high  hills  in  it,  and  at  a  sufficient  distance  from 
the  snowy  mountains  of  the  continent,  and  where 
the  heat  is  from  sixty  to  ninety  degrees,  is  the 
most  favourable  situation  ;  for  it  enjoys  an  equal 
temperature,  secure  from  bleak  winds.  In  the 
three  or  four  summer  months,  the  air  of  England 
is  as  mild  as  the  tenderest  lungs  need  breathe, 
and  there  can  be  no  use  in  leaving  this  country 
from  May  until  October ;  but  for  his  abode  during 
the  other  months,  the  consumptive  patient  should 
remove  to  such  a  situation  as  has  been  mentioned. 


308  Commentaries  on  the 

The  exercise  which  he  can  take  with  the  most 
pleasure,  and  with  the  least  fatigue,  will  be  the 
most  desirable, 

In  his  diet  he  must  abstain  from  all  wine  and 
spirituous  liquors,  and  either  wholly,  or  as  much 
as  he  well  can,  from  meat.  There  are  some,  who 
are  very  averse  from  vegetables  and  all  faiina- 
ceous  food,  and  to  such  a  moderate  indulgence  of 
their  taste  must  be  allowed,  lest  a  total  abstinence 
should  weaken  the  patients  more  than  the  distem- 
per :  the  cravings  of  the  appetite,  though  not  en- 
tirely to  be  gratified,  yet  are  not  in  any  illness  to 
be  wholly  disregarded.  The  water  which  is  used 
should  be  the  purest  that  can  be  had,  such  as 
springs  out  of  the  Malvern  hills,  or  distilled  wa- 
ter. Those  waters  which  are  loaded  with  lime- 
stone and  mineral  acids,  will  be  extremely  perni- 
cious. I  have  great  reason  to  believe,  that  such 
impure  waters  have  a  strong  tendency  to  obstruct 
the  lymphatic  glands,  and  make  them  become 
scirrhous  and  ulcered,  even  in  adults,  who  have 
no  hereditary  strumous  taint ;  and  I  think  I  have 
evidently  seen  such  dispersed  by  the  use  of  purer 
waters. 

Sailing,  so  as  to  be  out  at  sea  for  some  months, 
has  been  tried  by  some  for  whom  I  have  been  con- 
sulted, and  they  have  thought  it  useful.  How- 
ever, it  has  failed  in  others ;  and  I  can  go  no  fur- 
ther in  its  commendation,  than  to  say,  that  con- 
sumptive patients  have  borne  it  well,  even  those 
whose  principal  symptom  was  a  spitting  of  a  great 
quantity  of  blood  ;  which  complaint  has  not  been 
in  the  least  aggravated  by  a  voyage  of  six  weeks, 


Hi^ory  and  Cure  of  Diseases.     309 

notwithstanding  the  sea-sickness  was  so  great,  as 
to  make  the  patient  vomit  excessively  during  the 
whole  time. 

A  disagreeable  tickhng  in  the  throat,  causing  a 
constant  provocation  to  cough,  is  sometimes  so 
importunate  as  to  force  the  patient  to  have  re- 
course to  various  means  of  procuring  some  present 
relief:  a  few  raisins  will  sometimes  answer  this 
purpose ;  for  which  innumerable  other  sweet  and 
soft  things  have  been  employed,  as  a  little  liquo- 
rice-root tea,  rob  of  elder,  currant  jellv,  jelly  of 

,  1*1  .7  w        J  J    ^ 

qumce-seeds  sweetened  with  some  syrup,  a  mix- 
ture of  oil,  honey,  and  lemon-juice,  to  which,  or 
similar  compositions,  it  is  sometimes  requisite  to 
add  a  small  portion  of  syrup  of  white  poppies.  A 
lump  of  sugar  moistened  with  a  few  drops  of  tinc- 
tura  opii  camphorata  has  been  very  serviceable. 
Of  all  which  it  must  be  remembered,  that  they 
can  only  afford  a  little  temporary  ease,  that  they 
do  not  contribute  in  the  least  to  the  cure  of  the 
distemper,  that  they  pall  the  appetite,  and  there- 
fore should  be  used  very  sparingly. 


CHAPTER  73. 

Pidonum  Colica. 

There  appear  two  species  of  this  disorder,  one 
of  which  may  be  called  the  acute,  and  the  other 
the  chronical.  In  the  former,  the  pain  of  the  sto- 
mach and  bowels  comes  on  suddenly,  and  is  ex- 
cessively great,  joined  with  an  obstinate  costive- 


310  Commentaries  on  the 

ness,  and  sometimes  with  a  stupor  and  loss  of  un- 
derstanding, and  ends  in  a  palsj  of  the  hands,  if 
not  in  death.  The  chronical  begins  with  dull 
pains  of  the  bowels,  not  always  accompanied  with 
costiveness,  which  sometimes  increase  so  as  to  be 
very  tormenting,  sometimes  are  inconsiderable,  or 
cease  ;  they  continue  in  this  way  for  half  a  year, 
for  two,  for  three,  for  five,  or  for  ten  years,  before 
the  hands  become  paralytic :  at  which  time  in  both 
these  colics  there  rises  in  several,  but  not  in  all,  a 
swelling  on  the  back  of  one  or  of  both  hands, 
about  the  beginning  of  the  metacarpal  bone  of 
the  middle  finger,  of  the  size  of  a  small  nut,  with- 
out pain  or  change  of  colour.  After  the  more 
violent  colicky  pains  have  ceased,  and  the  palsy 
has  come  on,  a  dull  pain  of  the  stomach  has  re- 
mained, accompanied  with  flying  pains  all  over 
the  body,  with  very  little  appetite,  if  not  with 
sickness  and  vomiting.  The  patients  have  conti- 
nued gradually  to  lose  their  flesh  (particularly  in 
the  ball  of  their  thumb)  and  their  strength,  and 
not  long  before  death  have  grown  delirious  and 
blind.  The  legs  have  been  paralytic  for  a  night, 
and  I  have  remarked  some,  but  not  many  cases, 
in  which  they  too  as  well  as  the  hands  have  been 
afiected  with  a  lasting  palsy. 

Anxiety,  restlessness,  and  want  of  sleep,  harass 
these  patients  almost  as  much  as  the  pain  ;  they 
are  perpetually  turning  themselves  in  bed,  and 
when  they  are  able  to  keep  out  of  it,  they  are 
walking  to  and  fro  all  day.  Muscular  pains  all 
over  the  body,  (more  particularly  of  the  scapulae) 
extreme  languor,  hiccups,  want  of  appetite,  vomit- 
ing and  a  drawing  in  of  the  navel,  are  not  unusual 


History  and  Cure  of  Diseases.       311 

attendants  upon  a  fit.  A  quiet  sort  of  delirious 
talkativeness,  without  any  fever,  will  continue  in 
some  for  a  little  while  after  the  fit  has  ceased.  In 
a  chronical  Saturnine  colic  the  fits  have  kept  re- 
turning every  two  or  three  months  for  several 
years,  lasting  from  one  week  to  a  month  or  lon- 
ger. In  time,  as  the  distemper  becomes  stron- 
ger, and  the  body  weaker,  the  fits  return  more 
frequently  ;  and  even  in  the  intervals  the  patients 
are  far  from  being  perfectly  well.  The  pulse  is 
less  quickened  in  the  fit,  than  might  be  expected 
from  such  exquisite  anguish.  When  the  difficulty 
of  procuring  stools  is  conquered,  the  patient  finds 
some  relief  from  them,  and  often  not  much.  A 
person  has  been  apparently  dying  in  a  fit  of  this 
colic,  and  in  two  days  has  been  well  enough  to  go 
abroad.  Some  of  these  patients  have  expired 
suddenly;  and  such  an  event  may  probably  have 
been  owing  to  the  peculiar  mischief  which  the 
nerves  suffer  from  the  poison  of  lead. 

Upon  opening  the  abdomen  of  one,  who  died 
of  this  colic,  nothing  preternatural  could  be  disco- 
vered. 

All  the  solutions  and  calxes  of  lead  will  certain- 
ly occasion  this  disease.  The  acute  colic  perhaps 
arises  from  a  large  quantity  of  this  poison  taken 
in  a  short  time  ;  and  the  chronical  from  very  small 
quantities  persisted  in  for  a  long  time.  Experi- 
ence had  taught  mankind  these  singular  eflects  of 
lead  near  two  thousand  years  ago ;  and  it  has  not 
yet  been  clearly  and  satisfactorily  discovered  that 
they  have  ever  been  produced  by  any  other  cau- 
ses, though  some  have  been  suspected.     It  is  re- 


3 IS  Commentaries  on  the 

markable,  that  the  chronical  Saturnine  colic  has 
often  attacked  only  one  person  in  a  large  family, 
all  of  which,  as  far  as  could  be  learned,  lived  in 
the  same  manner.  But  this  must  not  be  urged  as 
an  argument,  that  it  could  not  be  produced  by 
lead  ;  because  it  would  prove  equally  against  any 
other  external  cause.  The  very  small  quantity  of 
this  poisonous  metal,  which  is  sufficient  to  pro- 
duce the  peculiar  symptoms,  makes  it  extremely 
difficult  to  trace  its  passage  into  the  stomach. 
Three  grains  of  sugar  of  lead,  taken  every  day 
for  four  days,  brought  on  colic,  costiveness,  inquie- 
tude, and  loss  of  appetite.  Thirty  drops  of  the 
Saturnine  tincture  taken  every  day  for  a  month 
created  a  colica  Pictonum,  which  was  long  trou- 
blesome, though  cured  at  last.  It  is  hard  to  esti- 
mate the  precise  quantify  of  lead  in  these  thirty 
drops,  but  I  judge  it  can  hardly  exceed  a  grain. 
In  the  tinning  of  copper  vessels  much  lead  has  ge- 
nerally been  mixed  with  the  tin,  and  if  one  of  the 
family  were  to  use  a  greater  quantity  of  what  had 
been  boiled  in  such  vessels,  especially  if  he  were 
fond  of  acid  sauces  prepared  in  them,  this  would 
affi^rd  the  ready  means  of  accounting  for  that  per- 
son's being  singled  out  as  the  only  suffl[3rer.  Dri- 
ed acid  fruits,  or  their  jellies  or  rob,  or  pickles 
made  in  tinned  or  glazed  vessels,  or  vinegar  if  it 
were  kept  any  time  in  such,  might  easily  be  made 
the  vehicles  by  which  the  lead  was  conveyed  into 
the  stomach ;  and  the  liking  which  some  have  for 
these,  and  the  indifference,  or  aversion  of  others, 
may  account  for  the  unequal  portions  of  lead, 
which  may  fall  to  the  share  of  different  persons 
in  the  same  family.  This  poison  might  also  lurk 
in  some  of  the  liquors  used  in  the  same  house,  and 


History  and  Cure  of  Diseases.       313 

not  in  others ;  and  besides,  like  all  other  nervous 
poisons,  may  have  stronger  effects  upon  peculiar 
constitutions.  Three  or  four  persons,  who  drank 
only  white  Lisbon  wine  from  half  a  pint  to  a  pint 
daily,  have  complained  of  this  colic,  and  a  conse- 
quent palsy,  of  which  I  suspected  the  wine  was 
the  cause  ;  and  the  good  effects  in  one  of  them 
upon  leaving  it  off  confirmed  my  suspicion. 

The  acute  species  of  this  distemper  has  never 
occurred  to  me,  unless  among  plumbers,  or  paint- 
ers, or  those  who  had  been  exposed  to  the  fumes 
of  melted  lead,  the  dust  of  old  lead,  or  its  calxes. 

The  unknown  manner  in  which  the  lead  is  in- 
troduced into  the  stomach  in  the  chronical  colic 
makes  probably  the  great,  and  often  unconquera- 
ble difficulty  of  curing  it.  For  if,  from  not  being 
aware  how  they  take  this  poison,  they  continue 
to  take  it  on,  no  remedies  can  be  of  any  avail ; 
and  accordingly  most  of  these  cases  have  proved 
incurable.  Many  children  probably  die  of  this 
distemper,  (though  confounded  with  their  other 
bowel  complaints)  which  they  contract  by  having 
play-things  painted  with  white  or  red  lead,  and 
by  putting  them,  as  they  are  apt  to  do,  into  their 
mouths.  The  painters  of  these  play-things  are 
liable  to  this  illness ;  and  I  have  had  them  under 
cure  for  it. 

The  first  attack  even  of  the  acute  species  of  this 
colic  has  not  always  ended  in  a  palsy ;  and  by  quit- 
ting the  employment  which  occasioned  it,  the  cure 
of  a  very  bad  tit  has  not  been  succeeded  by  a  re- 
lapse.    Some  active  purge  to  procure  a  passage, 

40 


314<  Commentaries  on  the 

and  opium,  if  it  be  necessary,  to  allay  the  pain, 
and  soothe  the  convulsions  of  the  bowels,  or  a 
warm  balh,  and  sometimes  a  blister  to  the  belly, 
have  proved  the  most  successful  remedies  in  a 
violent  fit  of  the  colica  Pictonum.  Aromatic  and 
bitter  infusions  seem  to  be  pointed  out  after  the 
fit  is  over,  as  the  properest  means  to  recover  the 
stomach  and  intestines  from  all  the  ill  effects  of  the 
Saturnine  poison,  and  to  prevent  or  to  cure  the 
paralytic  weakness,  which  so  generally  succeeds 
to  repeated  fits.  Bath  water,  from  its  friendly 
effects  upon  debilitated  stomachs,  promises  to  be 
useful  in  this  disease ;  and  though  some  have 
found  no  benefit,  yet  others  have  been  much  re- 
stored at  Bath,  and  perhaps  the  sooner  for  having 
used  those  waters  both  inwardly  and  outwardly. 
There  is  a  further  use  in  a  Bath  journey  to  those 
who  are  afflicted  with  the  chronical  colic ;  for  by 
changing  their  manner  of  life,  and  their  liquors, 
and  cuhnary  vessels,  they  may  hope  to  cut  off  the 
communication  which  the  lead  had  found  to  their 
stomachs,  and  against  which,  by  being  unknown, 
they  were  at  a  loss  how  to  guard  themselves  at 
their  own  homes. 


CHAPTER  74. 
Pituita. 


An  inundation  of  phlegm,  almost  to  a  degree  of 
choking,  especially  in  a  morning,  is  to  many  a 
very  afflicting  complaint,  and  is  chiefly  heard  of 
among  those  whose  strength  has  begun  to  decline, 


History  and  Cure  of  Diseases.       315 

either  by  the  approach  of  age,  or  by  the  shock  of 
some  distemper. 

This  phlegm  has  been  much  lessened  by  a  vo- 
mit, to  the  great  relief  of  the  patient ;  afterwards, 
to  keep  it  under,  it  has  been  found  advisable  to 
take  every  day  half  a  scruple  of  columbo  root 
with  one  grain  of  long  pepper,  in  powder  or  in 
pills  ;  to  which  may  be  occasionally  added  a  grain 
of  aloes,  if  there  be  any  tendency  to  costiveness, 
which  would  much  aggravate  this  complaint. 


CHAPTER  75, 

Prostaice  Scirrhus. 

A  SCIRRHUS  of  the  prostate  gland  has  been  ob- 
served only  in  adults,  and  chiefly  those  who  were 
in  the  decline  of  life.  The  symptoms  are,  some 
degree  of  tenesmus,  a  pain  in  expelling  hard  faeces, 
and  a  frequent  irritation  to  make  water,  which 
comes  away  with  pain,  stretching  sometimes  to 
the  extremity  of  the  urethra,  and  passing  up  to 
the  kidney.  In  the  advanced  state  of  this  mala- 
dy, a  bloody  mucus  follows  the  urine,  and  the  tes- 
ticles swell.  The  ulcer  has  sometimes  penetrat- 
ed into  the  rectum,  and  wind  has  passed  through 
the  ulcer  into  the  urethra,  and  come  out  with  the 
urine. 

There  is  a  great  resemblance  between  these 
symptoms  and  those  of  a  stone  in  the  bladder; 
and  the  two  distempers  are  not  always  readily 


■  t 

1 


^316  Commentaries  on  the 

distinguishable.  The  two  principal  criteria  are, 
that  in  a  diseased  prostate  the  pain  precedes,  and 
in  the  stone  it  follows  the  making  of  water ;  then, 
riding  in  a  carriage,  or  on  horseback,  which  so 
much  increases  the  bloody  water  and  anguish  of 
a  calculous  patient,  is  borne  in  a  scirrhus  of  the 
prostate,  even  in  its  ulcered  state,  without  any  ag- 
gravation of  the  pain,  or  any  more  copious  dis- 
charge of  bloody  mucus.  Wherever  this  disorder 
is  suspected,  the  assistance  of  a  surgeon  should 
be  desired,  who  by  an  examination  will  seldom 
fail  to  discover  the  swelling,  if  it  be  considerable ; 
but  in  the  early  state  of  this  disorder  I  have  known 
surgeons,  after  they  have  Examined,  differ  in  their 
opinions  about  the  state  of  this  gland.* 

A  scirrhous  prostate  hardly  admits  of  a  cure. 
Mercurials  have  appeared  to  do  mischief.  A  de- 
coction of  the  Peruvian  bark,  with  as  much  extract 
or  powder  of  hemlock  as  can  be  borne  without 
giddiness,  is  at  least  safe.  An  opiate  civster 
made  of  five  or  six  ounces  of  water  either  warm 
or  cold,  and  from  thirty  to  a  hundred  or  more 
drops  of  tinctura  opii,  cannot  be  enough  com- 
mended for  the  important  services  which  is  capa- 
ble of  doing  these  patients.  One  of  them  taken 
constantly  at  bed-time  will  always  insure  a  tolera- 
ble night ;  and  it  may  be  repeated  in  the  day, 
whenever  the  pain  is  excessive,  with  a  certain  ef- 
fect of  procuring  ease.  Beside  these,  I  know  no 
other  useful  instructions,  which  these  patients  can 
have  from  a  physician ;  for  their  own  prudence 
will  teach  them,  that  regular  hours,  temperance, 

*  Sfie  above,  chapter  16,  on  the  stone. 


History  and  Cure  of  Diseases.     317 

and  a  strict  abstinence  from  •all  heating  food  and 
liquors,  must  be  rigorously  observed. 


CHAPTER  re. 

Pruritus  Cutis. 

The  scrotum  of  men,  and  the  pudenda  of  wo- 
men, are  subject  to  be  afflicted  in  a  very  torment- 
ing manner  with  itching,  which  has  continued  for 
many  years.  In  women  this  complaint  is  often 
joined  with  the  fluor  albus,  and  may  be  partly 
owing  to  the  irritation  of  this  acrimonious  humour 
drying-  upon  their  skin  for  want  of  being  duly 
washed  off. 

There  is  besides,  an  universal  itching  of  the 
skin,  without  any  eruption,  or  jaundice,  familiar  to 
very  old  men,  and  to  those  whose  health  is  much 
broken  with  gout  or  palsy,  harassing  them  both 
day  and  night,  and  hardly  suffering  them  to  get 
any  sleep.  Elderly  men  often  experience  likewise 
a  slighter  itching  about  the  scapulae. 

Warm  bathing  has  been  tried  with  very  little 
success.  A  wash  of  spirit  of  wine  has  allayed 
the  itching  for  an  hour.  An  infusion  of  white  hel- 
lebore root,  as  directed  under  cutis  vitia,  has  in 
some  cases  made  an  effectual  cure.  A  very  bene- 
ficial lotion  has  also  been  [)repared  from  a  solu- 
tion of  alum,  from  sea- water,  tar-water,  and  a  de- 
coction of  staves-acre.     In  some  constitutions  it 


318  Commentaries  on  the 

has  been  judged   useful  to  open  an  issue  in  the 
thigh.     1  know  no  use  of  any  internal  medicines. 


CHAPTER  77, 

Puerperium, 

Beside  great  marks  of  weakness,  and  of  a  shat- 
tered constitution,  left  by  difficult  labours  and  pu- 
erperal fevers ;  and  beside  some  diseases,  as  men- 
tioned under  their  proper  heads ;  a  thick  miliary 
eruption  has  covered  every  part  of  the  skin  in  a 
lying-in  woman,  without  any  one  bad  symptom, 
and  has  lasted  three  days.  Was  this  entirely  ow- 
ing to  keeping  her  too  hot  ?  It  has  also  been  ob- 
served, that  sometimes  a  little  before,  or  a  few 
days  after  the  end  of  the  first  month,  one  of  the 
thighs  has  begun  to  be  painful,  not  without  fever, 
and  has  swelled  to  an  enormous  size,  with  great 
hardness,  and  inability  to  extend  the  leg.  This 
swelling  has  continued  near  a  month,  before  the 
thigh  has  been  reduced  to  its  natural  size,  and  be- 
fore the  use  of  it  has  been  fully  restored. 

The  paralytic,  and  maniacal  complaints,  to 
which  the  puerperal  state  is  subject,  have  been 
sooner,  and  more  perfectly  cured,  than  when  they 
have  been  brought  on  by  any  other  causes.  The 
puerperal  fever  must  be  treated  like  other  similar 
fevers.     Bleeding  is  proper  in  the  beginning. 


History  and  Cure  of  Diseases.       319 

CHAPTER  rs. 

Purpurem  Macula, 

Some  children,  without  any  alteration  of  their 
health  at  the  time,  or  before,  or  after,  have  had 
purple  spots  come  out  all  over  them,  exactly  the 
same  as  are  seen  in  purple  fevers.  In  some  pla- 
ces they  were  no  broader  than  a  millet-seed,  in 
others  they  were  as  broad  as  the  palm  of  the 
hand.  In  a  few  days  they  disappeared  without 
the  help  of  any  medicines.  It  was  remarkable, 
that  in  one  of  these,  the  slightest  pressure  was 
sufficient  to  extravasate  the  blood,  and  make  the 
part  appear  as  it  usually  does  from  a  bruise. 

A  boy  four  years  old,  for  several  days  had  swell- 
ings rise  on  his  knees,  legs,  thighs,  buttocks,  or 
scrotum.  The  part  affected  was  not  discoloured, 
and  when  at  rest,  was  easy,  but  could  not  be 
moved  without  some  degree  of  pain.  Together 
with  these  swellings  there  appeared  red  spots, 
sometimes  round,  sometimes  angular,  a  quarter  or 
half  an  inch  broad,  which  on  the  second  day  be- 
came purple,  and  afterwards  yellow,  just  as  it 
happens  from  a  bruise.  The  child  continued  per- 
fectly well  in  all  other  respects.  These  swelhngs 
ceased  to  appear  in  about  ten  days ;  but  the  red 
spots  continued  coming  out  a  few  days  longer. 

Another  boy  five  years  old,  was  seized  with 
pains  and  swellings  in  various  parts,  and  the  penis 
in  particular  was  so  distended,  though  not  disco- 
loured, that  he  could  hardly  make  water.     He 


3S0  Commentaries  on  the 

had  sometimes  pains  in  his  belly,  with  vomiting, 
and  at  thai  time  some  streaks  of  blood  were  per- 
ceived in  his  stools,  and  the  urine  was  tinged  with 
blood.  When  the  pain  attacked  his  leg,  he  was 
unable  to  walk ;  and  presently  the  skin  of  his  leg 
was  all  over  full  of  bloody  points.  After  a  truce 
of  three  or  four  days  the  swellings  returned,  and 
the  bloody  dots,  as  before.  These  dots  became 
paler  on  the  second  day,  and  almost  vanished  on 
the  third.  The  child  struggled  with  this  uncom- 
mon disorder  for  a  considerable  time,  before  he 
was  entirely  freed  from  it. 

The  first  of  these  boys  immediately  grew  bet- 
ter after  being  gently  purged  :  the  other  took  a 
decoction  of  the  bark  for  several  days  without 
any  manifest  good  effect. 


CHAPTER  79. 

Hheumatisfnus. 

The  rheumatism  is  a  common  name  for  many 
aches  and  pains,  which  have  yet  got  no  peculiar 
appellation,  though  owing  to  very  different  cau- 
ses. It  is  besides  often  hard  to  be  distinguished 
from  some,  which  have  a  certain  name  and  class 
assigned  them :  it  being  in  many  instances  doubt- 
ful, whether  the  pains  be  gouty,  or  venereal,  or 
strumous,  and  tending  to  an  ulcer  of  the  part  af- 
fected. 

There  are  two  different  appearances  of  the 
rheumatism,  one  of  which  may  be  called  the 
acute,  and  the  other  the  chronical. 


Uistovy  and  Cure  of  Diseases.        32 i 

The  acute  species  is  attended  with  great  rest- 
lessness, and  intolerable  pain  upon  moving  the 
affected  joint,  which  hkewise  swells  and  acquires 
a  faint  blush  of  redness.  The  degree  of  fever, 
as  far  as  is  denoted  by  the  quickness  of  the  pulse, 
less  injures  the  faculties  both  of  body  and  mind, 
in  the  rheumatism,  than  in  any  other  distemper ; 
for  what  might  be  considerable  enough  to  make 
others  delirious,  will  scarcely  make  these  patients 
lose  their  appetites,  or  shew  much  sign  of  distress, 
or  of  sinking  under  their  illness.  The  pains  and 
swellings,  contrary  to  what  happens  in  the  gout, 
have  in  the  first  fit  seized  successively  many  dif- 
ferent parts,  seldom  remaining  long  in  any,  and 
have  continued  in  this  manner  sometimes  for  more 
than  two  months.  These  patients  are  subject  to 
excessive  sweats  without  any  relief.  Many  of 
them  have  their  pains  greatly  increased  by  the 
warmth  of  a  bed  :  but  this  is  not  constant;  for 
some,  especially  in  the  chronical  species,  are  easier 
in  bed. 

The  rheumatism  has  in  more  than  one  or  two 
patients  returned  once  or  twice  a  year  for  several 
years,  and  upon  account  of  this  circumstance  it  is 
a  borderer  upon  the  gout,  and  many  would  doubt 
to  which  of  the  two  distempers  it  properly  be- 
longed ;  for  though  one,  who  has  had  a  fit  of  a 
rheumatism,  may  have  a  second  or  third,  yet  it 
has  seldom  been  found  to  be  regularly  periodical 
in  its  returns ;  oftener  indeed  it  has  never  return- 
ed at  all.  The  rheumatism  is  undoubtedly  near- 
ly allied  to  the  gout;  and  fits  of  it  have  been  more 
common  in  children  born  of  gouty  parents;  as  if 
it  were  a  prelude  to  what  they  were  afterwards 
41 


R... 


3^S  Commentaries  on  the 

to  suffer.  The  chronical  species  equally  partakes 
of  the  palsy;  for  there  is  always  a  trembling, 
weakness,  and  numbness  left  for  some  time  in  the 
limb  affected,  and  in  the  chronical  sort  the  use  has 
at  last  in  many  been  wholly  taken  away.  A 
rheumatic  pain  in  the  shoulder  of  a  woman  gradu- 
ally weakened  the  arm,  till  it  became  almost  pa- 
ralytic and  useless  :  in  six  or  seven  months  the 
motion  of  the  arm  began  to  return,  and  after  the 
use  of  Buxton  water,  was  perfectly  restored. 
Strumous  constitutions  likewise  have  appeared 
particularly  liable  to  pains,  and  swellings,  either 
rheumatic,  or  by  every  mark  exactly  resembling 
them.  Such  have  either  forerun,  or  accompanied 
strumous  ulcers,  and  collections  of  matter ;  and 
strumous  opthalmies  have  more  than  once  been 
changed  into  rheumatic  pains  of  the  limbs.  A 
pain  with  a  swelling  fixed  in  a  single  part,  as  the 
knee,  or  wrist,  without  cv^r  removmg  to  any 
other,  is  hardly  to  be  called  rheumatic,  and  is  more 
likely  to  be  a  cramp,  or  strain,  or  strumous,  that 
is,  to  have  a  tendency  to  an  ulcer  from  some  in- 
ternal cause.  '  An  exception  however  must  be 
made  in  regard  to  the  sciatica,  which  is  of  the 
rheumatic  kind,  though  it  be  fixed  in  the  same 
part :  as  for  the  lumbago,  it  seems  to  be  rather  a 
cramp,  or  strain. 

The  chronical  differs  from  the  acute  rheuma- 
tism in  being  joined  with  little  or  no  fever,  in  hav- 
ing a  duller  pain,  and  commonly  no  redness,  but 
the  swellings  are  more  permanent,  and  the  dis- 
ease of  much  longer  duration  ;  for  if  the  acute 
species  have  continued  some  months,  the  other 
has  continued  for  many  years.     It  oftener  hap- 


J 


I 


History  and  Cure  of  Diseases,        3SB 

pens  that  the  fits  return,  at  no  certain  intervals, 
till  they  have  brought  on  a  deplorable  weakness, 
or  entirely  destroyed  the  health.  Both  kinds  of 
the  rheumatism  attack  indiscriminately  males  and 
females,  rich  and  poor. 

The  rheumatism  has  appeared  so  early  as  in  a 
child  only  four  years  old,  and  1  have  seen  several 
afflicted  with  it  at  the  age  of  nine  years  :  in  v^hich 
it  differs  from  the  gout,  which  J  never  have  ob- 
served before  the  years  of  puberty. 

Many  of  the  worst  rheumatisms  have  never  of- 
fered to  go  beyond  the  external  muscles  and 
joints ;  yet  1  have  seen  some,  in  whom  the  rheu- 
matism has  spontaneously  passed  these  bounds, 
and  attacked  the  stomach,  or  head.  As  in  a 
great  number  of  rheumatisms  this  has  happened 
so  seldom,  it  may  be,  that  those  disorders,  in  which 
the  stomach  and  head  have  been  affected,  were 
more  truly  gouty,  or  strumous,  or  belonged  to 
the  chronical  rather  than  acute  rheumatism.  An 
immoderate  vomiting,  and  restlessness,  and  entire 
loathing  of  every  thing,  which  ended  in  death,  oc- 
curred in  the  case  of  one  man,  whose  complaints 
in  many  respects  partook  more  of  the  nature  of 
rheumatism,  than  of  gout. 

The  rheumatism  is  not  more  like  the  gout  in 
its  appearance,  than  in  the  little  progress  which 
has  hitherto  been  made  in  settling  the  proper  me- 
thod of  cure ;  which  perhaps  is  partly  owing  to 
the  different  disorders,  which  have  been  called  by 
this  name.  In  the  acute  sort,  bleeding  has  been 
much  trusted  to,  which  is  so  much  dreaded  in  that 


3S4  Commentaries  on  the 

very  similar  distemper  the  gout :  and  it  seems  to 
be  plainly  pointed  out  in  young  persons  of  vigor- 
ous  health,  who  have  contracted  this  illness  by 
the  common  causes  of  inflammatory  distempers, 
such  as  being  exposed  to  cold  air  when  they  were 
heated  with  labour.  But  as  much  as  I  have  been 
able  to  observe,  the  benefit  of  large  and  repeated 
bleedings  is  in  most  cases  far  from  being  clear 
and  unquestionable.  One  of  the  worst  rheuma- 
tisms, which  I  remember,  immediately  succeeded 
a  most  profuse  bleeding  of  the  nose,  which  con- 
tinued so  long,  as  almost  to  exhaust  the  patient, 
and  to  bring  his  life  into  imminent  danger.  Some- 
thing like  this  has  happened  in  a  second  instance. 

Among  the  common  people,  tradition  has  pre- 
served the  use  of  the  linum  catharticum,  and 
other  very  strong  purges  ;  but  these  have  not  been 
attended  with  such  good  effects,  as  to  establish 
their  general  usage.  Sweating  is  another  evacua- 
tion, which  has  been  employed  both  in  the  acute 
and  chronical  rheumatism,  and  sometimes,  as  it 
has  seemed,  with  advantage ;  but  it  is  notorious, 
that  these  patients  are  of  themselves  subject  to 
excessive  sweats  without  any  mitigation  of  the 
distemper.  I  have  remarked  some  instances,  in 
which  warm  bathing  seemed  prejudicial,  but  not 
one,  in  which  it  did  any  good  in  either  species  of 
this  distemper.  Cold  bathing  has  often  been  use- 
less, but  at  least  as  often  serviceable.  A  blister 
has  relieved  the  more  fixed  pains  of  the  chronical 
rheumatism  ;  and  the  volatile  and  saponaceous  li- 
niments have  been  rubbed  in  upon  the  parts  af- 
fected, and  perhaps  with  benefit.  The  motion  of 
a  carriage  has  been  so  far  from  increasing  these 


History  and  Cure  of  I)i8ease,%.        S25 

pains,  even  when  they  have  been  very  bad,  that 
8ome  patients  have  been  easier  when  traveUing, 
than  when  sitting  still  in  their  chairs. 

Preparations  of  quicksilver  huve  been  frequent- 
ly given  with  purging  medicines,  and  sometimes 
with  an  opiate  ;  but  there  will  be  cause  of  hesitat- 
ing about  making  use  of  mercurial  preparations, 
since  they  have  indubitably  in  many  cases  con- 
stantly brought  on  fits  of  the  rheumatism  :  and 
never  could  be  used,  though  several  times  trie.d, 
without  having  this  effect.  The  rheumatism  has 
m  some  persons  been  the  sure  attendant  upon  a 
venereal  disorder,  probably  in  consequence  of  the 
mercury  which  had  been  used  for  its  cure. 

The  Peruvian  bark,  gum  guiacum,  the  Portland 
powder,  preparations  of  antimony,  a  mixture  of  ni- 
tre and  volatile  salt,  the  powder  or  infusion  of 
bogbean  and  other  bitters,  are  supposed  to  pos- 
sess some  specific  virtue  in  the  cure  of  this  mala- 
dy ;  but  all  these  must  be  looked  upon  as  being  in 
a  state  of  probation  only,  not  as  being  yet  estab- 
lished in  the  class  of  efficacious  remedies.  Opi- 
um, notwithstanding  Sydenham's  objections,  has 
at  least  proved  a  safe  and  effectual  remedy  for 
the  purpose  of  mitigating  the  pains,  and  of  procur- 
ing easy  nights  of  sleep ;  and  has  not  only  palliat- 
ed the  symptoms,  but  has  been  judged  to  contri- 
bute to  the  cure  of  the  rheumatism,  more  by  its 
calming,  than  by  its  sudorific  power :  nor  do  I 
know  that  it  is  more  efl[icacious,  when  administer- 
ed in  Dover's  powder,  or  mixed  with  antimony, 
than  when  given  alone. 


3g6  Commentanes  on  the 

Pains  of  the  hips  are  well  known  to  arise  some- 
times from  a  morbid  state  of  the  joint,  of  a  very 
different  nature  from  the  rheumatism."^ 


CHAPTER  80. 
■^  Semen  Virile, 

Intemperance  in  venereal  pleasures  is  punished 
with  various  symptoms  of  weakness,  generally 
causing  a  greater  languor  of  mind,  than  of  body, 
proceeding  from  the  reflection  upon  that  miscon- 
duct, which  has  done  this  injury  to  the  health. 
In  these  cases  the  semen  will  come  away  too 
promptly  both  iri  sleep,  and  in  the  day-time,  and 
sometimes  without  the  person's  having  any  sense 
of  it.  Cold  bathing  has  been  useful  in  such  com- 
plaints ;  but  living  in  a  more  cautious  manner, 
and  abstaining  from  all  the  practices,  which  occa- 
sioned them,  is  the  most  effectual  remedy,  and 
what  I  believe  will  seldom  fail.  I  have  in  two 
persons  known  the  semen  of  a  chocolate  colour, 
probably  owing  to  the  breaqh  of  some  small  blood 
vessel.  This  discolouring  has  continued  for  some 
time,  but  without  any  bad  consequences. 


See  above,  chapter  21, 


History  and  Cure  of  Diseases.     S27 


CHAPTER   8L 


Singultus, 


A  HICCUP  is  the  companion  both  of  chronicat 
and  acute  distempers.  It  has  been  the  forerun- 
ner of  epilepsies,  and  has  attended  palsies,  and 
seldom  fails  to  be  one  of  the  symptoms  of  diseas- 
ed livers,  and  sometimes  will  belong  to  simple  ob- 
structions of  the  gall-ducts.  Various  other  dis- 
eases of  the  stomach  and  bowels,  have  this  for 
one  of  the  symptoms ;  whether  they  arise  from 
ruptures,  scirrhi,  and  ulcers,  or  from  mischief 
done  by  the  violent  operation  of  drastic  antimoni- 
al,  or  corrosive  mercurial  medicines.  All  these 
have  been  the  causes  of  hiccups,  which  have  last- 
ed for  months,  and  for  years ;  some  almost  con- 
stant, and  others  with  intervals  of  various  lenghts. 
One  or  two  patients  have  been  harassed  with 
them  for  several  months  without  any  other  sign 
of  ill  health. 

A  hiccup  is  a  symptom  of  a  dangerous  nature 
in  acute  distempers  :  it  has  begun  on  the  first  day 
of  a  fever,  and  lasted  for  the  whole  seven  days, 
that  the  patient  lived,  without  yielding  to  any  of 
the  known  helps.  In  other  less  violent,  though 
at  last  mortal,  fevers  it  has  admitted  of  no  relief 
for  twenty  days.  The  cure  of  it  must  either  de- 
pend on  the  cure  of  the  primary  distemper ;  or  it 
must  be  treated  with  antispasmodics,  such  as  mo- 
derate doses  of  opium,  or  a  spoonful  of  the  musk 
julep  frequently  administered. 


3S8  Comnientaries  on  the 

'    CHAPTER  82. 

Sitis. 

An  unquenchable  thirst,  and,  what  is  often 
joined  with  it,  a  dropsy,  or  diabetes,  are  not  so 
much  distempers  themselves,  as  attendants  upon 
great  disorders  of  the  abdominal  bowels ;  which 
most  commonly  admit  of  no  relief,  but  end  in 
deaths  However,  the  primary  malady,  though 
fatal  at  last,  will  in  some  cases  be  two  or  three 
years  undermining  the  health,  before  the  patient 
sinks  under  it ;  during  all  which  time  he  is  harass- 
ed with  this  most  distressing  ail,  which  is  usually 
accompanied  with  a  feverishness,  and  loss  of  ap- 
petite, and  strength,  shortness  of  breath,  and  oth- 
er signs  of  a  ruined  constitution. 

Formidable  as  this  symptom  is,  yet  it  has  not 
always  been  fatal ;  the  original  distemper  in  a  few 
instances  having  admitted,  and  happily  met  with 
a  cure.  The  thirst  has  been  increased  by  indulg- 
ing the  desire  of  drinking ;  and  has  been  relieved 
by  the  use  of  a  little  nitre.  But  unless  the  prin- 
cipal disease  can  be  put  into  a  successful  method 
of  cure,  it  is  plain,  that  this  among  other  symp- 
toms dependent  upon  it,  though  it  may  be  check- 
ed, yet  is  not  likely  to  he  entirely  subdued. 


History  and  Cure  of  Biseases.       B29 

CHAPTER    83. 

Spasmus, 

Involuntary  agitations,  and  cramps  or  involun- 
tary contractions,  in  those  muscles  which  should 
obey  the  will  if  much  increased,  are  called  convul- 
sions. Every  external  muscle  of  the  body  is  lia- 
ble to  spasms,  as  our  senses  inform  us,  and  proba- 
bly all  the  internal  muscles  likewise.  These  pre- 
ternatural contractions  of  the  muscles  have  some- 
times burst  a  small  blood-vessel,  and  the  extrava- 
sated  blood  running  under  the  skin  has  discolour- 
ed it  black  and  blue,  and  yellow,  as  it  appears 
when  bruised. 

Cramps  and  involuntary  agitations  are  familiar 
to  gouty  and  hysteric  patients,  and  often  forerun 
and  attend  palsies,  and  are  the  principal  symp- 
toms of  epilepsies  and  St.  Vitus's  dance.  The 
causes  of  them  are  either  in  the  nerves  only  of 
the  part  affected,  or  in  the  brain  and  spinal  mar- 
row. That  species  of  cramp,  called  chorda  penis, 
is  usually  occasioned  by  the  acrimony  of  the  vene-, 
real  virus  affecting  those  particular  nerves  ;  but 
it  may  be  brought  on  by  other  similar  local  mis- 
chief, for  I  have  twice  known  it  without  any  vene- 
real infection.  A  perpetual  agitation  of  the  left 
leg  and  arm  arose  from  a  purulent  mass,  into 
which  the  right  side  of  the  brain  was  changed,  its 
natural  texture  being  obliterated.  Instances  of  a 
like  nature  with  these  perpetually  occur, ^whether 
the  irritation  of  the  part,  or  the   preternatural 

42 


330  Commentanes  on  the 

state  of  the  brain  and  spinal  marrow,  be  owing  to 
any  disease,  or  to  some  external  violence. 

On  the  sixth  day  after  the  extirpation  of  a  scirr- 
hous testicle,  the  patient  began  to.  complain  of  a 
difficulty  of  swallowing,  or  rather  of  a  sudden 
sense  of  suffocation  :  and  in  two  days  the  jaw  be- 
came immoveably  locked,  and  the  patient  soon 
died.  I  observed  the  same  happen  in  an  hysteric 
woman,  without  any  sore  or  wound.  She  died 
about  the  tenth  day ;  opium  and  warm  bathing 
proving  ineffectual. 

After  a  dangerous  fever  the  sleep  of  a  man  wajs 
sometimes  broken  by  excessive  cramps.  Two  or 
three  days  previous  to  such  a  bad  night,  there  us- 
ed to  appear  about  the  middle  of  the  tibia  a  small 
soft  tumour  hardly  bigger  than  a  pea ;  and  by  this 
never-failing  sign  the  approach  of  the  cramp  was 
certainly  known. 

In  the  fevers  of  children  the  face  is  sometimes 
drawn  to  one  shoulder.  I  have  often  seen  this, 
but  never  knew  it  continue  long  after  the  fever 
was  cured.  This  happens  both  in  continual,  and 
in  intermittent  fevers.  A  similar  circumrotation 
of  the  face,  sometimes  to  the  right,  sometimes  to 
the  left  shoulder,  has  continued  for  a  long  time  in 
several  elderly  women  who  had  no  other  com- 
plaint ;  but  in  them  this  involuntary  motion  has 
been  so  little  violent,  as  to  be  overpowered  by  a 
very  small  force,  and  therefore  has  ceased  while 
the  head  rested  upon  a  pillow. 

Fevers  in  the  West  Indies,  as  we  are  told,  by 
some  disturbance  of  the  brain,  give  occasion  to 


History  and  Cure  of  Diseases.      381 

those  very  formidable  cramps  called  emprosthoto- 
nus,  and  opisthotonus ;  somo  less  derangement 
has  been  left  by  fevers  in  England,  in  consequence 
of  which  cramps  of  the  legs  have  returned  every 
night  in  a  most  tormenting  manner.  But  the 
change  made  in  the  state  ot  the  nerves  by  a  fever 
has  not  always  in  this  respect  been  for  the  worse; 
for  the  only  time  that  one  person  was  free  from 
spasmodic  agitations,  was  during  a  fever. 

Sleep  favours  the  access  of  cramps,  as  it  does 
of  all  other  nervous  complaints  ;  and  therefore 
they  are  chiefly  complained  of  in  the  night;  they 
attack  some  just  as  they  are  sinking  into  sleep, 
and  others  just  as  they  are  waking  at  the  usual 
time,  or  forcibly  awake  them  in  what  vvoiild  else 
have  been  the  middle  of  their  sleep.  Acids  have 
sometimes  brought  them  on. 

Slight  cramps  are  cured  by  altering  the  posi- 
tion of  the  limb.  JEther  has  been  rubbed  into 
the  calves  of  the  legs  at  bed-time  with  success. 
Habitual  cramps  have  yielded  to  five  drops  of 
tinctura  thebaica  mixed  with  forty  drops  of  tinctu- 
ra  assefoetidae  taken  every  night.  A  fit  of  the 
gout  has  been  judged  to  suspend  the  power  of 
cramps ;  but  I  am  much  more  strongly  convinced, 
that  the  gout  is  apt  to  breed  and  foster  them.  A 
course  of  warm  bathing  effectually  cured  an  ob- 
stinate cramp,  which  had  for  some  months  kept 
the  body  crooked,  and  one  hand  immoveably 
clenched,  so  that  the  nails  had  grown  into  the 
palm,  and  made  sores.  The  waters  of  Bath  have 
been  useful,  as  it  is  probable,  more  on  account  of 


33S  Commentaries  on  the 

their  warmth,  than  of  any  other  qualities.     The 
cold  bath  has  been  tried  without  any  benefit. 


CHAPTER  84. 

Sputa  Cruenta, 

A  CONSIDERABLE  spitting  of  blood,  proceeding 
not  from  the  stomach  with  the  action  of  vomiting, 
nor  trickhng  down  from  the  back  of  the  nostrils, 
but  coming  from  the  lungs,  is  a  very  just  ground 
of  alarm  to  the  patient.  This  is  very  seldom  seen 
in  children;  many  having  kept  free  from  this,  as 
v^^ell  as  from  the  other  symptoms  of  a  pulmonary 
consumption,  during  their  childhood,  though  they 
were  born  of  consumptive  parents,  and  died  of 
that  disease  before  they  were  twenty.     This  com- 

laint  has  made  its  first  appearance  at  all  times  of 

ife  from  puberty  to  old  age. 


ph 
lift 


The  danger  belonging  to  it  will  be  greater  in 
proportion  to  the  greater  number  and  degree  of 
the  other  consumptive  symptoms,  with  which  it  is 
accompanied,  and  to  the  tenderness  of  the  age  at 
which  it  comes  on.  A  spitting  of  blood  seems 
sometimes  to  be  the  whole  complaint,  so  that  not 
even  a  cough  shall  be  joined  with  it,  but  the  blood 
will  be  brought  up  with  as  little  effort  as  the  easi- 
est phlegm :  it  does  indeed  most  commonly  de- 
note an  unsound  state  of  the  lungs;  but  from  ma- 
ny facts  it  seem  reasonable  to  infer  the  possibility 
of  a  slight  haemorrhage  from  the  vessels  of  the 
lungs,  or  trachea,  while  the  lungs  are  otherwise 


History  and  Cure  of  Diseases.*      838 

in  a  healthy  state,  and  consequently  with  as  little 
dan^jer,  as  from  the  hsemorrhoidal  vessels,  or 
those  of  the  nose,  especially  if  it  happen  at  the 
meridian  of  life.  I  have  seen  a  man  in  good 
health  at  seventy,  who  for  fifty  years  had  never 
been  free  from  spitting  of  blood  above  two  years 
together.  In  others  I  have  known  it  return  every 
now  and  then  for  as  long  time.  In  a  peripneu- 
mony  a  bloody  mucus  will  be  brought  up  as  the 
patient  recovers,  and  no  cough,  nor  sign  of  any  in- 
jury remain.  A  peripneumony,  in  which  bloody 
phlegm  had  been  spit  up  for  two  or  three  days, 
gradually  abated,  and  the  patient  seemed  to  be 
recovered ;  but  the  cough  soon  came  on  again, 
and  in  a  month's  time  there  was  a  great  wasting 
of  the  flesh,  and  a  difficulty  of  breathing,  with 
many  signs  of  approaching  death  :  after  going  into 
the  country,  and  riding,  the  patient  lost  his  cough 
and  shortness  of  breathing,  and  lived  healthy  for 
many  years.  A  very  considerable  wound  may  be 
made  in  the  lungs  of  a  healthy  man,  as  I  have 
known,  by  a  bullet,  without  either  death,  or  a 
consumption  following.  The  loose  texture  of  the 
lungs,  and  their  great  number  of  large  blood-ves- 
sels, together  with  their  constant  motion,  and  the 
impossibility  of  any  topical  application,  might 
make  one  fear  that  a  large  haemorrhage  from 
them  could  never  be  stopped,  and  must. prove  fa- 
tal ;  yet  I  have  known  such  a  breach  entirely  cur- 
ed,* as  was  probable,  from  there  being  no  return 
of  spitting  blood  for  near  forty  years ;  and  I  do 

*  In  the  second  volume  of  Transactions  of  a  Society  for  the  Ira- 
proveineut  of  Medical  and  Chirurgical  Knowledge,  is  given  an  ac- 
count of  a  dissection,  where  a  wound  of  the  lungs  had  been  pe rfert- 
ly  healed.     E. 


334      *         Commentaries  on  the 

not  remember,  as  common  as  this  complaint  is,  to 
have  seen  more  than  one,  who  was  evidently  ex- 
hausted by  large  and  repeated  returns  of  it,  and 
might  truly  be  said  to  have  bled  to  death.  A 
man  has  survived  at  least  for  two  years  the  loss 
of  a  pint  of  blood  from  the  lungs  every  day  for  a 
n^onth.  Not  only  the  common  motion  of  the 
lungs  is  borne  without  much  increasing  their  hae- 
morrhage, but  a  perpetual  sickness  and  vomiting 
during  a  voyage  of  six  weeks  did  not  apparently 
make  a  spitting  of  blood  more  profuse. 

These  facts  may  afford  some  hope  in  accidents 
of  this  kind ;  which  however  most  frequently  end 
in  a  quick  consumption,  or  leave  a  lasting  cough, 
growing  worse  every  winter,  and  making  the 
breathing  more  laborious.  Among  the  notes 
which  I  have  taken  of  these  cases,  1  do  not  find 
that  I  have  reason  to  recommend  any  new  reme- 
dy, or  that  I  have  made  any  practical  remarks 
upon  those  which  are  in  common  use.  The  ne- 
cessity of  keeping  quiet,  and  cool,  is  evident,  and 
therefore  of  avoiding  all  strong  liquors,  high  sau- 
ces, hot  rooms,  costiveness,  loud  speaking,  and 
exertions  of  all  kinds.  Two  or  three  large  spoon- 
fuls of  tincture  of  roses  may  be  frequently  taken 
with  advantage ;  and  there  will  sometimes  in 
these  cases  be  occasion  for  a  gentle  opiate.  If  I 
give  so  much  to  the  established  practice  as  to  al- 
low of  one  or  two  small  bleedings,  where  the  spit- 
ting of  blood  has  not  already  occasioned  too  great 
a  loss,  I  must  think  a  caution  necessary  against 
large  and  repeated  bleedings,  which  would  proba- 
bly conspire  with  the  distemper  to  exhaust  the 
patient. 


History  and  Cure  of  Diseases,       335 


CHAPTER  85. 

Sleatomata. 

Two  children,  the  one  four,  the  other  eight 
years  old,  had  tumours  all  over  them,  some  of  the 
size  of  sDiall  nuts,  others  as  larjoje  as  nutmegs.  I 
judged  them  to  be  of  a  steatomatous  kind.  One 
of  these  children  had  a  voracious  appetite  :  they 
were  both  very  weakly,  and  soon  pined  away,  and 
died. 

Softish  subcutaneous  tumours,  between  the  size 
of  a  pea  and  that  of  a  small  nut,  without  any  pain, 
have  been  very  numerous  in  the  arms  only  ;  and 
in  another  they  were  chiefly  seated  about  the  an- 
cles, elbows,  and  knees,  and  were  suspected  to  be 
venereal.  In  a  third,  similar  tumours  continued 
six  years  in  the  arms,  and  then  spontaneously  re- 
treated.    They  have  lasted  so  long  as  ten  years. 

The  large  steatomatous  swellings,  or  wens,  are 
safely  cut  out,  and  they  seem  to  admit  no  other 
cure. 


CHAPTER  86. 

Stranguria, 

The  strangury,  or  a  frequent  and  most  urgent 
desire  to  make  water,  with  excessive  pain  in  the 
attempt,  is  sometimes  an  attendant  upon  pregnaa- 


336  Commentariea  on  the 

cj,  and  usually  accompanies  diseases  of  the  womb, 
of  the  prostate  gland,  and  of  the  bladder,  hard 
faeces  obstructing  the  rectum,  and  injuries  of  the 
urethra  from  fresh,  or  frequent,  or  ill-cured  go- 
norrhoeas. 

It  has  been  caused  by  some  sorts  of  food,  and 
some  medicines,  as  pepper,  particularly  long  pep- 
per, mustard-seed,  horse-radish,  and  other  acrid 
vegetables,  and  rough  cyder.  This  pain  has 
come  on  from  taking  six  drams  of  diuretic  salts, 
and  very  certainly  follows  the  use  of  spirit  of  tur- 
pentine, one  dram  of  which  is  on  this  account  a 
greater  dose  than  (*an  generally  be  borne.  Can- 
tharides  are  well  known  to  possess  the  same 
power  beyond  all  other  substances,  even  applied 
externally,  as  well  as  when  taken  into  the  sto- 
mach. It  is  one  among  the  many  instances  of  our 
imperfect  knowledge  of  the  animal  economy,  that 
we  can  by  no  means  understand  how  the  cantha- 
rides  should  pass  so  quietly  without  hurting  the 
various  passages,  and  some  of  them  of  exquisite 
fineness,  through  which  they  are  carried  to  the 
bladder,  and  yet  irritate  this  part  in  that  extraor- 
dinary manner,  which  is  too  often  experienced 
from  the  application  of  blisters.  The  difficulty  of 
accounting  for  this  is  increased  by  our  finding, 
that  one  blister  has  sometimes  occasioned  this  ir- 
ritation, though  afterwards  in  the  same  person, 
and  the  same  illness,  five  blisters  applied  at  once 
have  had  no  such  effect :  and  what  is  called  a  per- 
petual blister,  after  it  has  been  kept  open  seven 
years  without  doing  the  least  hurt  to  the  bladder, 
has  all  at  once,  without  any  apparent  reason,  af- 


History  and  Cure  of  Diseases.        337 

fected  it  so  strongly,  as  to  make  it  impossible  to 
continue  the  blister  any  longer. 

There  are  persons,  who  from  some  unknown 
peculiarity  in  their  constitution,  have  such  a  dis- 
position to  the  strangury,  that  after  the  applica- 
tion of  a  blister  this  complaint  has  continued  upon 
them  for  several  months:  others,  without  any  of 
the  known  causes,  have  frequently  had  returns  of 
it  throughout  their  whole  lives  from  their  infancy, 
particularly  in  every  illness,  whatever  it  were, 
though  no  blister  had  been  applied.  It  is  a  disor- 
der familiar  to  elderly  persons,  both  men  and  wo- 
men :  and  it  has  been  suspected,  that  a  tendency 
to  this  evil  has  been  created  by  a  gouty  habit. 

No  medicines  taken  into  the  stomach  have  ap- 
peared to  do  much  good  in  the  strangury.  Oil, 
and  gum  arable,  roay  perhaps  do  a  little;  but  I 
have  reason  to  believe,  that  camphor,  like  other 
substances  of  the  same  class,  will  create  a  dysury, 
rather  than  prove  its  cure.  The  uva  ursl  is  at 
best  a  doubtful  remedy,  and  yet  it  is  capable  of 
doing  something  to  the  parts  concerned  in  secret- 
ing and  containing  the  urine,  for  in  one  patient  it 
was  trequently  tried,  and  it  always  changed  the 
urine  to  a  green  colour.  Bougies  have  afforded 
great  ease  in  difficulties  of  urine  from  venereal  in- 
juries of  the  urethra,  but  they  have  seldom  effect- 
ed a  complete  and  lasting  cure.  Injections  of  oil 
into  the  urethra,  sitting  over  the  steam  of  warm 
water,  warm  fomentations  of  the  perinaeum,  and 
about  the  os  pubis,  have  often  procured  a  truce 
with  these  pains;  but  an  opiate  clyster  made  of  a 
quarter  of  a  pint  of  water,  and  from  twenty  to  a 
43 


338  Commentaries  on  the 

hundred  or  more  drops  of  tinctura  opii,  has  most 
readily  cured  the  strangury  arising  from  a  blis- 
ter, and  has  been  the  most  certain  and  expeditious 
temporary  rehef  in  those  cases,  which  admitted 
nothing  further. 


CHAPTER  87. 

Struma. 

That  habit  of  body  is  called  strumous,  or  scro- 
fulous, or  the  evil,  in  which  the  lymphatic  glands 
are  swelled  with  little  or  no  pain.  This  happens 
most  commonly  in  the  neck,  and  armpits,  more 
rarely  in  the  groin.  Those  of  the  mesentery  are 
found  liable  to  the  same  disorder,  and  probably  all 
the  other  internal  lymphatic  glands.  Together 
with  these  appearances,  the  end  of  the  nose,  and 
both  the  lips  are  apt  to  swell,  and  the  eye-lids  are 
often  inflamed,  and  ulcered.  These  ails  have 
sometimes  followed,  or  been  joined  with  cuta- 
neous eruptions,  and  purulent  discharges  from  the 
ears.  Some  constitutions  experience  frequent  re- 
turns of  an  inflammation  of  the  tonsils,  which  lasts 
a  few  days,  not  without  fever:  in  others  there  is 
an  enlargment  of  them,  which  sometimes  continues 
for  a  long  time  with  considerable  uneasiness  to 
the  patient,  and  some  difficulty  of  swallowing. 

Infants  and  children  are  particularly  subject  to 
strumous  disorders,  and  more  especially  the  weak- 
ly with  very  fair  skins.  After  the  age  of  puberty 
the  tumours  of  the  glands,  and  the  inflammation 


History  and  Cure  of  Diseases.     339 

of  the  eje-lids,  usually  begin  to  abate,  and  In 
adults  often  disappear  entirely;  but  in  some  per- 
sons, upon  their  retreat  from  the  outward  parts 
of  the  body,  they  seem  to  fall  upon  the  lungs, 
whence  arise  incurable  consumptions.  But  chil- 
dren are  not  the  only  sufferers  by  this  malady;  for 
I  have  noted  eight  or  ten  healthy  persons,  in 
whom  the  lymphatic  glands  began  first  to  be  en- 
larged after  the  age  of  thirty,  and  the  swelling  in 
some  of  them  did  not  shew  itself  till  near  their 
sixtieth  year.  The  origin  of  this  mischief  in  these 
adults  was  probably  to  be  found  in  the  unwhole- 
someness  of  their  diet,  or  situation.  The  use  of 
a  very  hard  water  was  suspected  to  have  made 
one  of  them  scrotulous  ;  for  he  began  to  be  so 
after  using  it  constantly  for  a  few  years,  and  con- 
tinued so  long  as  he  used  it,  but  upon  leaving  it 
off,  all  the  scrofulous  appearances  left  him.  It  is 
most  probably  owing  to  some  bad  quality  of  the 
water,  that  swellings  of  the  throat  are  endemial 
in  some  parts  of  England,  and  notoriously  among 
the  inhabitants  of  the  Alps  ;  though  1  by  no  means 
think  it  owing  to  the  use  of  snow-water,  to  which 
it  has  been  attributed  :  for  I  believe,  on  account 
of  its  great  purity,  this  would  bo  one  of  the  best 
remedies  they  could  employ.* 

*  The  inhabitants  of  Rheims  had  been  so  afflicted  with  strumous 
diseases,  that  they  maintained  an  hospital  for  the  sole  purpose  of 
curing  such  patients.  They  then  made  use  of  no  other  water  than 
what  they  had  from  wells.  After  a  machine  was  constructed,  which 
brought  the  water  from  a  neighbouring  river,  and  distributed  it 
into  all  quarters  of  the  city,  it  was  observed  that  scrofulous  disor- 
ders became  less  common  ;  and  in  the  space  of  thirty  years  the 
number  of  these  patients  was  reduced  to  one  half  of  what  it  had 
usualy  been:  it  continued  to  decrease  so  fast,  as  to  give  occasion 
for  thinking,  Uiat  the  greater  part  of  the  revenues  of  the  hospital 
might  be  applied  to  other  purposes.  Soc.  RoT/ale  de  Medecine,  vol. 
ii.  Hist.  p.  280. 


340  Commentaries  on  the 

Beside  these  swelled  glands,  which  make  one 
species  of  the  evil,  there  is  another,  which  is  call- 
ed the  Joint  evil,  which  has  begun  in  the  hands, 
or  elbows,  or  feet,  with  a  small  tumour  situated 
so  deep,  that  the  bones  are  often  affected.  These 
have  continued  two  or  three  years,  before  they 
have  come  to  ulcers,  which  have  been  of  such  a 
malignant  nature,  as  at  length  to  make  the  hands 
or  feet  almost  useless,  or  to  make  the  fingers  arid 
toes  fall  off.  Are  the  diseases  of  the  head  of  the 
thigh-bone,  and  its  socket,  and  also  what  is  called 
the  white  swelling  of  the  knee,  to  be  referred  to 
this  class  ?  This  seems  not  unlikely,  as  they  have 
been  found  joined  in  the  same  person  with  the 
usual  marks  of  an  inveterate  scrofula. 

Some  strumous  appearances  have  shewn  them- 
selves not  long  after  the  measles,  and  small  pox^. 
and  this  has  created  a  suspicion,  that  this  altera- 
tion of  the  health  was  to  be  attributed  to  some  re- 
liques  of  those  diseases  :  but  this  has  happened 
too  seldom  within  my  observation  to  give  any  just 
grounds  for  such  an  opinion,  which  perhaps  has 
been  entertained  the  more  readily,  because  the 
patients,  or  their  friends,  were  unwilling  to  think 
the  scrofulous  complaints  hereditary,  or  constitu- 
tional. 

The  scrofula,  and  lues  venerea,  when  they 
meet,  seem  greatly  to  exalt  the  malignity  of  each 
other. 

The  swellings  of  the  lymphatic  glands  in  the 
neck,  and  armpits,  have  continued  above  twenty 
years  without  any  other  variation,  than  being  a 


I 


History  and  Cure  of  Diseases.        341 

little  enlarged  upon  catching  cold  ;  but  this  is  ex- 
traordinary, and  happens  but  seldom  :  they  thore 
usually  either  lessen  by  degrees,  and  vanish  in  not 
many  months,  or  in  a  very  few  yeai  s ;  or  else  in- 
flame, and  suppurate.  The  larger  break  into 
smalldr  parts  with  a  slight  degree  of  itching  in  the 
skin  previously  to  their  going  away ;  and  tlie 
smaller  first  grow  softer,  and  so  gradually  sink 
down,  and  are  reduced  to  their  natural  size  ;  in- 
stances of  all  which  are  very  common.  When, 
mstead  of  dispersing,  these  tumours  inflame  and 
grow  red,  they  are  a  long  time  in  coming  to  a 
sore,  in  which  state  they  are  slowly  dissolved  into 
an  imperfect  pus,  and  afterwards  heal.  These 
sores  have  never  within  my  observation  shewn  a 
disposition  to  turn  cancerous  in  children,  and  only 
in  two  or  three  adults. 

I  never  saw  any  occasion  for  using  poultices, 
plasters,  or  warm  covering  to  strumous  swellings. 
They  cannot  be  wanted  to  mitigate  the  pain,  be- 
cause it  is  so  inconsiderable  ;  and  if  it  be  meant 
to  disperse  them  by  plasters,  it  may  be  doubted 
whethier  any  have  a  power  of  this  kind  ;  but  if  the 
application  be  intended  to  make  them  suppurate, 
it  is  doing  that,  which  too  much  pains  can  never 
be  taken  to  prevent ;  for  they  cannot  terminate  in 
a  worse  manner.  If  this  event  cannot  be  hinder- 
ed, and  the  glands  spontaneously  tend  to  become 
ulcerous,  they  should  be  suffered  to  break  of 
themselves  without  the  help  of  a  knife  or  a  caus- 
tic ;  and  the  mildest  defensative  plaster  is  all  the 
further  care  which  they  require.  The  scrofulous 
inflammations  of  the  eye-lids,  and  eyes,  sometimes 
make  bleeding   necessary ;   and  they  have   been 


34S  Commentaries  on  the 

much  more  benefited  by  leeches,  than  by  taking 
away  blood  in  any  other  manner :  two  or  three 
may  be  put  to  each  temple  once  or  twice  a  week 
for  a  considerable  time.  Many  external  applica- 
tions to  the  eyes  are  recommended,  all  which  have 
been  often  found  of  very  little  service,  except  soft 
cataplasms  put  between  two  pieces  of  fine  linen, 
and  so  applied  to  the  eyes,  and  touching  the 
edges  of  the  sore  eye-lids  every  night  with  some 
softened  animal  fat,  which  will  hinder  their  being 
glued  together  in  the  night;  for  the  force  used  to 
open  them  in  a  morning  keeps  them  constantly 
raw  and  sore. 

Mercurial  medicines  have  been  judged  to  hurt, 
rather  than  to  help  scrofulous  patients;  and  per- 
haps strumous  distempers  have  been  aggravated 
by  the  accession  of  a  venereal  infection,  chiefly  on 
account  of  the  preparations  of  mercury  which 
these  require.  Sea-water  internally,  and  exter- 
nally, extract  of  hemlock,  bark  infused  in  purging 
water,  or  taken  in  substance  at  night,  .while  purg- 
ing waters,  or  salts,  are  used  in  the  morning,  burnt 
spunge,'sal  sodae,  issues,  and  perpetual  blisters, 
are  the  principal  means  which  have  been  recom- 
mended as  alteratives  of  a  strumous  habit ;  all 
which,  as  experience  has  taught,  may  be  employ- 
ed with  safety  ;  but  the  reputation  of  their  effica- 
cy is  far  from  being  fully  established.  Where 
the  patient  has  not  perseverance  enough  to  conti- 
nue the  use  of  any  of  these  for  a  proper  length  of 
tiuie,  he  may  do  himself  some,  and  I  believe  con- 
siderable service,  by  a  temperate  course  of  life, 
and  by  drinking  no  other  water  than  such  a  pure 
one  as  that  of  Malvern. 


History  and  Cm*e  of  Diseases.       843 


CHAPTER  88. 

Tenesmus, 

A  CONSTANT  needing,  or  wanting  to  go  to  stool, 
though  Httle  or  no  faeces  could  be  voided,  has 
been  owing  to  the  following  causes :  hard  faeces, 
which  had  loaded  the  rectum,  and  which  could 
not  be  expelled  without  assistance  ;  a  scirrhus  of 
the  womb,  of  the  rectum,  or  of  the  prostate 
gland  ;  a  stone  in  the  bladder;  a  strangury,  parti- 
cularly, one  brought  on  bj  cantharides ;  and  a 
weakness  of  the  sphincter  ani  left  by  an  apoplexy, 
or  a  difficult  labour.  It  is  usually  troublesome  for 
a  little  while  after  a  dysentery  ;  and  has  accompa- 
nied the  colica  Saturnina,  and  a  prolapsus  of  the 
inner  coat  of  the  intestine. 

A  tenesmus  is  usually  increased  by  standing  or 
walking,  and  relieved  by  sitting.  When  it  is 
merely  owing  to  acrimony,  an  opiate  clyster  will 
be  the  best  remedy.  In  other  cases  the  relief  of 
this  uneasy  sensation  must  depend  upon  the  cure 
of  the  original  disease,  of  which  it  is  a  symptom. 


I 


CHAPTFR  89. 

Testiculus, 

Besides  tumours  of  the  testicles  from  external, 
or  venereal  injuries,  they  have  been  found  joined 
with  an  intermittent  fever,  coming  on  and  going 


344  Commentaries  on  the 

off  with  every  fit,  and  finally  ceased  upon  the  cure 
of  the  intermittent :  this  has  happened  more  than 
once.  A  common  cold  has  had  a  sieiilar  effect 
upon  several  persons.  A  scirrhous  prostate  gland 
has  made  the  testicles  swell ;  which  also  is  no  very 
uncommon  consequence  of  stones,  and  other  af- 
fections of  the  kidneys.  Without  any  manifest 
cause  a  swelling  has  begun  in  one  of  the  testicles, 
and  after  continuing  a  few  months  has  sponta- 
neously subsided.  A  tumour  of  them  has  at  other 
times  slowly  increased  for  many  years,  and  at  last 
made  the  whole  testicle  scirrhous,  which  has  been 
twenty  years  before  it  became  cancerous  and  fa- 
tal. A  fistulous  sore  has  formed  in  such  a  testi- 
cle, and  has  long  harassed  the  patient. 

Purges,  except  very  gentle  ones,  have  been  at 
least  useless.  Poultices  are  necessary  when  the 
pain  is  considerable.  Whether  there  be  pain,  or 
swelling,  a  bag-truss  is  of  indispensable  use  to 
suspend  the  scrotum.  There  is  no  cure  for  a  scir- 
rhous testicle,  but  castration  ;  and  this  may  be 
safely  performed,  if  the  spermatic  chord  be  in  to- 
lerable order  ;  but  where  this  too  is  diseased,  the 
case  admits  of  no  cure.  The  hydrocele  is  incon- 
venient, but  void  of  danger ;  and  may  be  suffici- 
ently relieved,  wit})out  pain  or  hazard,  by  tap- 
ping, as  often  as  there  is  occasion.  An  operation 
is  sometimes  performed  in  the  hydrocele,  which 
makes  a  lasting  cure. 


History  arid  Cure  of  Diseases,        3-15 

CHXpTER  90. 

Torpor, 

A  NUMBNESS,  or  sense  of  tingling  in  a  limb, 
which  is  commonly  called  its  being  asleep,  has 
been  experienced  in  every  part  of  the  body,  but 
chiefly  in  the  limbs,  and  particularly  the  extremi- 
ties. It  is  a  half  loss  of  the  sense  of  feeling,  and 
is  extremely  common,  though  a  total  loss  of  it  be 
so  rare  even  in  the  most  hopeless  palsies. 

A  numbness,  like  a  cramp,  has  been  either  a 
slight  complaint  brought  on  by  an  inconvenient 
posture,  or  other  trivial  causes,  unattended  with 
any  ill  consequences,  and  presently  removed ;  or 
else  it  has  arisen  from  that  preternatural  state  of 
the  nerves,  which  is  inconsistent  with  tolerable 
health,  or,  \i  may  be,  with  life,  and  has  been  the 
forerunner  of  convulsions,  palsies,  and  apoplexies. 
The  old  seem  most  subject  to  it,  and  both  sexes 
equally ;  in  youth,  females  have  oftener  been  suf- 
ferers than  males.  Where  a  torpid  state  of  any 
part  has  not  been  constant,  it  has  been  found  to 
come  on  chiefly  in  the  night,  owing  partly  to  a 
long  continuance  of  the  same  posture,  and  partly 
to  sleep,  which  favours  the  access  of  all  disorders 
in  which  the.  nerves  are  more  immediately  con- 
cerned. 

Numbnesses  are  familiar  to  broken  constitutions, 
and  such  as  have  been  derived  from  paralytic  pa- 
rents. They  have  been  the  forerunners,  the  at- 
tendants, and  followers  of  palsies,  and  apoplexies. 

44 


346  Commentaines  on  the 

and  are  commonly  joined  with  other  symptoms  of 
these  maladies.  This  very  frequently  makes  one 
of  the  numerous  complaints,  which  are  heard  of 
among  hypochondriac  and  hysteric  patients,  and 
has  continued  in  them  and  others  not  onlj  for  ma- 
ny months,  but  often  for  many  years,  and  then 
has  gone  off  without  having  done  any  mischief  to 
the  health.  The  whole  left  side  has  been  be- 
numbed for  five-and-twenty  years. 

The  true  nature  and  tendency  of  a  numbness 
'•^roay  be  best  known  by  its  attendant  circumstan- 
ces ;  for  if  it  be  associated  with  other  paralytic 
symptoms,  and  affect  a  considerable  part  of  the 
body,  especially  in  persons  derived  from  paralytic 
parents,  no  doubt  can  be  made  of  its  betokening 
mischief,  and  the  proper  preventives  of  palsies 
should  be  employed.  But  if  a  torpor  should  af- 
fect only  a  small  part,  as  one  or  two  fingers,  or 
toes,  and  be  united  with  no  other  symptoms,  or 
only  such  as  are  common  in  hypochondriac  disor- 
ders, the  less  notice  the  patient  takes  of  it,  the 
happier  he  will  be.  But  if  there  should  be  rea- 
sons tor  endeavouring  to  cure  this  more  innocent 
species  of  the  complaint,  blisters,  and  warm  bath- 
ing, have  been  found  the  most  serviceable  means ; 
cold  bathing,  and  bleeding,  have  been  found  pre- 
judicial;  the  gout  has  been  useless;  and  as  for 
electricity,  its  virtues  have  not  yet  been  sufficient- 
ly ascertained. 


^ 


History  and  Cure  of  Diseases.       34'; 


CHAPTER  91. 

Tremor. 

A  TREMBLING  of  the  hands,  or  a  shaking  of  the 
head,  may  be  judged  to  have  some  alhance  with 
paralytic,  and  apoplectic  maladies  ;  yet  it  has  been 
found  by  experience,  that  such  a  tremour  has 
often  continued  for  a  great  part  of  a  person's  hfe, 
without  any  appearance  of  further  mischief;  and 
therefore,  if  it  have  a  tendency  to  palsies,  it  is  a 
very  remote  one,  and  the  inconvenience  is  far 
more  considerable  than  the  danger.  Hypochon- 
driac persons  are  troubled  with  frequent  fits  of  it; 
hard  drinkers  have  it  continually  ;  and  some  de- 
grees of  it  usually  attend  old  age. 

This,  like  other  affections  of  the  nerves,  is 
greatest  in  a  morning,  and  is  aggravated  by  any 
disturbance  of  mind.  Coffee  and  tea  make  the 
hands  of  some  persons  shake  ;  and  yet  I  have 
known  strong  coffee  drunk  every  day  for  forty 
years,  by  one  who  was  remarkable  for  the  steadi- 
ness of  his  hands  even  in  extreme  old  age.  There 
are  many  others,  who  know  no  such  ill  effect  from 
these  liquors  ;  and  indeed,  if  it  were  general,  few 
Chinese,  and  Turks,  would  escape  it ;  but  their 
history  does  not  acquaint  us,  that  these  people 
are  more  subject  to  tremours,  than  those  of  other 
nations. 

If  any  medicines  are  wanted,  they  must  be  such 
as  are  found  serviceable  in  paralytic  and  hypo- 
chondriac complaints. 


348  Commentaries  on  the 

CHAPTER  92. 

Tussis, 

A  COUGH  seems  to  have  been  sometimes  occa- 
sioned either  by  an  acrimonious,  or  a  too  copious 
defluxion  on  the  trachea,  without  any  material, 
or  permanent  injury  of  the  lungs ;  or  merely  by 
disorders  of  the  stomach  and  bowels,  as  hath  ap- 
peared upon  dissections,  examples  of  which  are 
often  seen  in  children  with  worms,  and  swelled 
mesenteric  glands.  In  cases  where  the  lungs 
themselves  have  been  diseased,  it  is  observable 
that  they  are  sometimes  in  a  disposition  to  let  the 
mischief  spread  in  a  rapid  manner  all  over  them, 
and  in  a  very  short  time  become  a  fatal  consump- 
tion ;  while  in  other  instances  the  injured  part  pf 
the  lungs  has  seemed  to  remain  in  the  same  state 
for  twenty,  forty,  or  even  sixty  years,  with  very 
little  inconvenience  beside  the  cough,  so  that  the 
patient  has  grown  fat  with  it ;  or  else  the  disease 
of  the  lungs  has  spread  so  slowly,  that  though  the 
cough  has  become  a  little  worse  every  wjnter 
from  youth  to  old  age,  yet  it  has  not  been  till  to- 
wards the  end  of  a  long  life,  that  the  lungs  have 
become  so  diseased,  as  to  do  their  duty  with  that 
difficulty,  which  is  called  an  asthma.  Even  an 
ulcer  of  the  lungs,  as  was  adjudged  from  the 
blood  and  purulent  liquor  spit  up,  has  for  a  consi- 
derable time  kept  itself  confined  within  the  same 
bounds.  In  a  few  cases  the  ulcer  has  probably 
been  seated  in  a  capsula,  which  has  at  last  been 
coughed  up  with  great  efforts,  and  some  danger 
of  suffocation ;  after  which  there  has  been  a  total 


i 


History  and  Cure  of  Diseases.       849 

cessation  of  all  the  complaints,  the  sore  being  in 
all  probability  entirely  healed.  In  hysteric,  and 
convulsive  diseases,  arising  from  som^  disordered 
state  of  the  whole  system  of  nerves,  ^hose  serving 
to  respiration  have  among  the  rest  been  disturbed 
so  as  to  occasion  violent  roughs,  without  any 
more  injury  to  the  lungs,  than  the  convulsions  of 
the  limbs,  or  body,  occasion  in  those  parts,  which 
they  have  seized.  These  coughs,  and  those  aris- 
ing from  defluxions  upon  the  lungs,  are  attended 
sometimes  with  an  unusual  noise,  and  are  general- 
ly much  stronger,  than  consumptive  coughs  are, 
not  only  in  their  beginning,  but  even  in  their  ad- 
vanced state.  The  same  is  likewise  the  case 
with  those  coughs,  which  are  owing  to  some  hard 
body  fallen  into  the  trachea.  I  have  seen  a  vib- 
lent,  and  almost  perpetual  cough,  arising  from  a 
bone  fixed  in  the  windpipe,  which  had  lasted 
some  months  with  an  unusual  sound,  and  present- 
ly ceased  upon  coughing  up  the  bone. 

Coughs  have  molested  some  persons  alternate- 
ly with  opthalmies,  the  gout,  scald  head,  and  other 
cutaneous  disorders.  It  must  be  remembered, 
that  in  all  long  coughs  there  is  danger  of  a  con- 
sumption, and  therefore  a  cool  regimen  is  of  indis- 
pensable use,  in  order  to  keep  the  lungs  in  that 
state,  which  is  most  likely  to  hinder  the  sound 
parts  from  being  infected  by  the  diseased.  There 
have  been  too  many  examples  of  coughs  remain- 
ing in  a  tolerable  state  for  twenty  years,  and 
which  with  proper  care  might  have  remained  so 
for  twenty  more,  which  have  by  mismanagement, 
or  catching  cold,  been  joined  by  all  the  symptoms 
of  a  quick  consumptiori,  soon  terminating  in  death. 


350  Commentaries  on  the 

Hence  arises  a  difficulty  of  deciding,  whether  a 
cough  be  a  consumptive  one  :  most  coughs  natu- 
rally tend  to  a  pulmonary  phthisis  ;  and  though 
the  tendenc)^  be  sometimes  so  strong,  that  there 
is  no  hazard  of  being  mistaken  in  pronouncing 
the  cough  consumptive,  yet  in  many  instances  no 
physician  can  prognosticate  the  event,  unless  he 
be  able  to  predict  also  what  the  patient's  manner 
of  living  will  be,  and  whether  he  will  always  es- 
cape violent  colds,  and  peripneumonies. 

Abstemiousness,  change  of  air,  and  a  judicious 
use  both  of  bleeding,  and  of  opium,  have  proved 
the  best  means  of  soothing  a  troublesome  cough, 
and  of  hindering  it  from  becoming  a  dangerous 
one. 


I 


CHAPTER  93. 

Tussis  convulsiva. 

The  hooping-cough  is  most  common  among 
children,  and  is  undoubtedly  contagious  ;  it  is  a 
tedious  disorder,  lasting  often  for  several  months ; 
and  though  sometimes  slight,  yet  in  some  children 
it  proves  fatal.  An  inundation  of  phlegm,  or  a 
vomiting,  the  clearness  of  the  intervals,  and  the 
violence  of  the  fits,  may  generally  distinguish  it 
from  a  common  cough  in  the  very  beginning ;  but 
afterwards  it  cannot  be  mistaken,  when  the  expi- 
ration in  coughing  continues  so  long,  that  they 
can  hardly  recover  the  power  of  drawing  in  their 
breath,  which  is  done  at  last  with   a   peculiar 


History  and  Cure  of  Diseases.     351 

sound,  called  hooping ;  and  this  jprincipally  cha- 
racterizes this  distemper.  A  child  has  had  one  of 
these  coughs  three  months  before  the  hooping 
came  on.  The  violence  of  the  cough  sometimes 
makes  the  nose  bleed,  and  the  face  blackish,  and 
has  strained  the  eyes  so  as  to  do  them  a  lasting 
injury.  It  does  not  usually  attack  a  person  more 
than  once;  but  to  this  I  have  heard  some  few  ex- 
ceptions among  those  whom  1  have  attended  in  it, 
of  whom  more  than  one  have  assured  me  they 
had  been  ill  of  it  before. 

Old  persons  are  less  liable  to  this  malady,  but 
by  no  means  exempt  from  it :  I  have  seen  it  in  a 
woman  of  seventy,  and  in  a  man  of  fourscore.  A 
child  has  some  notice  of  the  approach  of  a  fit,  so 
as  to  be  able  to  run  to  his  nurse,  or  mother,  be- 
fore it  begins  ;  but  adults  are,  as  it  were,  over- 
powered at  once  upon  the  access  of  the  fit,  so 
that  they  fall  down  instantly,  as  in  an  apoplexy, 
but  very  soon  come  to  themselves  :  this  is  a  distin- 
guishing symptom  of  the  disease  in  those  who  are 
grown  up ;  and  if  they  have  not  before  been  sub- 
ject to  a  cough,  and  have  lately  been  in  the  way 
of  catching  this  distemper,  the  circumstance  of 
their  falling  down  in  this  manner  may  take  away 
all  doubt  about  the  nature  of  their  illness.  Fla- 
tulence in  an  extraordinary  degree  often  accom- 
panies this  cough. 

Experience  has  instructed  us,  that  a  change  of 
air  is  of  singular  use  in  abating  the  force,  and 
shortening  the  stay  of  this  distemper.  The  sto- 
mach is  so  much  disordered  in  it  by  being  over- 
loaded with  phlegm  and   oppressed  with  wind. 


35^  Commentaries  an  the 

that  it  seems  very  reasonable  to  relieve  and 
strengthen  this  part  by  the  help  of  rhubarb  and 
bitters.  The  hooping-cough  has  so  much  the  na- 
ture of  a  convulsion,  that  a  prudent  use  of  opium, 
together  with  musk,  lac  ammoniaci,  and  viaum  an- 
timonii,  might  probably  be  beneficial  ;  but  I  have 
not  seen  such  undoubted  success  from  these  medi- 
cines, as  to  be  confident  of  their  virtues.  As  for 
the  numberless  specifics,  which  are  every  where 
to  be  met  with,  I  have  nothing  to  say  in  their 
favour  from  my  own  observation. 


CHAPTER  94. 

Valetudo  conquassata. 

A  DANGEROUS  disease,  or  great  decay  of  the 
parts  necessary  to  life,  occasions  what  is  called  a 
broken  state  of  health  ;  by  which  is  meant  an  as- 
semblage of  many- or  most  of  the  following  com- 
plaints :  A  paleness,  or  sallowness  of  the  counte- 
nance; a  bloated  face;  thirst;  shortness  of  breath; 
palpitation  of  the  heart;  flatulence;  loathing  of 
food  ;  sickness  ;  frequent  making  of  water  ;  incon- 
tinence of  the  stools,  and  of  the  urine  ;  swelling  of 
the  legs;  wandering  pains;  spasms;  wasting  of 
the  flesh ;  weakness ;  lassitude ;  itching  of  the 
skin  ^tremblings  ;  numbnesses  ;  feverishness  ;  lan- 
guor ;  faintings ;  sleepiness  in  the  day-time ;  want 
of  sleep  at  night ;  forge tfulness. 


h 


History  and  Cure  of  Diseases.       358 


CHAPTER  95- 

Variolce, 

The  experience  which  I  have  had  of  inocula- 
tion, does  not  enable  me  to  add  any  thing  to  what 
has  been  already  estabhshed  in  relation  to  its  uti- 
lity, or  the  management  of  the  inoculated.  I  am 
sorry  to  liave  found,  that  this  operation  has  not 
always  secured  the  patient  from  having  the  small 
pox  afterwards,  if  the  eruption  have  been  imper- 
fect without  maturation.  1  attended  one  in  a  very 
full  small  pox,  which  ran  through  all  its  stages  in 
the  usual  manner ;  yet  this  person  had  been  ino- 
culated ten  years  before,  and  on  the  fifth  day  af- 
ter inoculation  began  to  be  feverish  with  a  head- 
ach  followed  by  a  slight  eruption,  which  eruption 
soon  went  off  without  coming  to  suppuration  ;  the 
place  of  inoculation  had  inflamed,  and  remained 
open  ten  days,  leaving  a  deep  scar,  which  I  saw. 

By  some  accident,  most  of  the  notes  are  lost, 
which  had  been  made  during  my  attendance  on  a 
great  number  of  patients  in  the  uninoculated 
small  pox  ;  therefore  I  shall  not  attempt  to  give  a 
full  history  of  this  distemper,  but  confine  myself 
to  the  relating  of  such  observations  as  are  justifi- 
ed by  the  few  remaining  papers. 

Many  instances  have  occurred  to  me,  which 
shew  that  one  who  has  never  had  the  small  pox, 
may  safely  associate,  and  even  lie  in  the  same  bed 
with  a  variolous  patient,  for  the  two  or  three  first 
days  of  the  eruption,  without  any  danger  of  re- 

45 


354  Commentaries  on  the 

ceiving  the  infection.  One  woman  continued  to 
suckle  her  infant  for  two  dajs  after  the  small  |;ox 
had  begun  to  appear  upon  her  ;  and  the  child  be- 
ing then  removed  escaped  the  distemper  for  that 
time,  but  was  unquestionably  capable  of  being  in- 
fected, because  he  catched  it  about  a  year  and 
half  after. 

Parents  have  several  times  judged  it  proper, 
when  one  of  their  children  has  fallen  ill  of  the 
small  pox,  not  to  send  those  away,  who  had  not 
had  this  distemper,  but  to  let  them  all  continue 
together  in  the  same  house,  and  often  in  the  same 
chamber.  About  the  sixth  day  alter  the  distem- 
per had  arrived  at  its  height  in  the  sic  k  child,  the 
others  have  for  the  most  part  begun  to  complain  ; 
and  therefore  it  is  probable  that  this  is  the  time, 
when  the  distemper  begins  to  be  communicable  ; 
the  infection  lying  dormant  about  the  same  num- 
ber of  days,  that  it  does  in  those  who  have  been 
inoculated.  But  there  are  much  greater  varieties 
in  this  way  of  taking  the  small  pox,  than  by  ino- 
culation, accordingly  as  persons  go  more  or  less 
into  the  way  of  receiving  the  breath  ol  the  sick 
person,  or  of  touching  things  daubed  with  the  va- 
riolous matter.  Two  children  were  constantly 
kept  in  the  sick  chamber,  and  yet  did  not  fall  ill 
till  a  month  after;  and  there  are  not  a  few  exam- 
ples of  persons,  who  have  seemed  to  be  equally 
exposed  to  the  infection,  and  yet  have  received  it 
at  different  times. 

An  excruciating  pain  in  the  loins  has  never  fail-         ^ 
ed  to  be  succeeded   by  a  bad  small  pox,  and  the         ; 
more  violent  the  pain  the  greater  has  been  the        -*■ 


I 


History  and  Cure  of  Diseases.       355 

danf^pp;  it  is  much  safer  to  have  it  between  the 
shoulders  ;  but  it  is  safest  to  have  none  in  any 
part  of  the  back. 

Excessive  vomiting  for  the  whole  time  before 
the  eruption  is  seldom  followed  bv  a  mild  disease; 
and  if  the  vomiting  be  continued  after  the  erup- 
tion "is  completed,  the  patient's  life  is  in  great 
danger,  even  though  the  small  pox  be  not  conflu- 
ent, as  I  have  seen  more  than  once. 

It  is  very  common  to  have  convulsions  precede 
a  mild  small  pox  in  children,  and  the  same  has 
been  known  in  some  adults  with  as  prosperous  an 
event. 

The  variolous  infection  does  some  force  to  the 
vessels,  which  supply  the  menstrual  discharge  in 
women  ;  and^in  the  worst  sort  of  small  pox  this 
evacuation  has  come  on  out  of  its  regular  course 
two  days  before  the  small  pox  has  begun  to  shew 
itself,  and  has  continued  to  flow  in  an  excessive 
manner.  It  has  sometimes  appeared  before  its  re- 
gular time,  together  with  the  eruption.  But  what 
I  have  more  usually  observed,  is,  that  this  uterine 
flux  in  almost  all  female  patients  has  begun  as 
soon  as  the  eruption  was  completed,  and  it  has 
continued  from  one  day  to  fixe.  This  discharge, 
though  sometimes  much  greater  than  the  natural 
one,  does  not  seem  to  check  the  progress  of  the 
small  pox,  nor  to  sink  the  patient's  strength,  and 
therefore  very  little  pains  need  be  taken  to  stop 
it,  even  though  we  had  any  ready  and  innocent 
way  of  doing  it. 


856  Commentaries  on  the 

That  very  formidable  symptom,  bloody  urine, 
has  come  on  about  the  fifth  day  from  the  first  sick- 
ness ;  the  eruption  in  the  mean  time  has  hardly 
risen  above  the  skin,  chiefly  shewing  itself  in  pur- 
ple spots  and  blotches,  and  resembling  variolous 
pimples  only  in  very  few  places,  The  stools  are 
likewise  bloody;  the  very  tears  have  been  like 
lotura  carnium ;  and  if  a  small  scratch  has  any 
where  been  made  in  the  skin,  the  blood  has  for 
many  hours  continued  to  ooze  out,  and  has  hard- 
ly been  stopped.  This  hopeless  state  has  been 
terminated  by  death  in  three  or  four  da^s  after 
the  eruption  ;  nor  have  I  remarked  one  exception. 
But  the  urine  may  be  discoloured  in  the  small 
pox,  and  have  a  hue  as  dark  as  coffee,  even  where 
there  is  no  reason  to  suspect  its  proceeding  from 
gravel,  and  yet  afford  no  ground  for  alarm,  if  not 
joined  with  other  bad  symptoms.  In  a  middling 
sort  of  small  pox,  the  urine  became  black  on  the 
fourth  day  of  the  eruption,  and  continued  so  for 
four  dayg.  In  another,  the  same  black  urine  be- 
gan on  the  second  day  of  the  sickness,  having  a 
sediment  like  coffee-grounds  for  two  days.  Both 
these  patients  went  on  prosperously,  without  any 
other  bad  or  unusual  syniptom.  The  pustules 
have  sometimes  shewn  themselves  not  very  diffe- 
rent from  their  general  appearance  in  a  middling 
sort;  but  the  interstices  have  been  filled  with 
small  round  purple  spots,  and  the  distemper  has 
been  fatal  on  the  third  day  of  the  eruption. 

It  has  been  remarked  above,  that  the  variolous 
virus  has  a  peculiar  etTect  in  exciting  the  uterine 
j8ux,  and  upon  this  property  of  it  perha|}s  depends 
its  well-known  effect  upon  pregnant  women»  who 


History  and  Cure  of  Diseases.       357 

usually  miscarry  on  the  seventh  or  eight  clay  fronoi 
the  first  eruption,  and  in  a  day  or  two  aiter  die. 
The  foetus  of  tliis  abortion  I  have  often  examined 
vs^ith  great  attention.  The  skin  of  it  has  been 
much  discoloured,  in  some  parts  of  a  dirty  red,  in 
others  blackish,  and  in  a  few  places  of  a  natural 
colour;  but  I  could  never  see  any  appearance  of 
a  variolous  eruption.  I  have  known  a  very  few 
pregnant  women,  who  have  gone  through  this 
distemper  without  miscarrying,  and  have  after- 
wards been  brought  to  bed  at  the  natural  time  ; 
but  I  could  never  see  upon  these  children  any 
such  marks  as  might  be  left  by  a  variolous  erup- 
tion ;  and  1  am  well  assured,  that  such  children 
have  afterwards  had  the  smaTI  pox.  A  young 
girl  was  opened,  who  died  full  of  the  small  pox, 
and  I  observed  that  none  of  the  bowels  or  inter- 
nal parts  shewed  the  least  marks  of  their  having 
any  variolous  pustules  :  now  the  foetus  in  utero 
seems  to  be  so  much  in  the  same  state  witii  the 
bowels,  that  if  these  are  never  the  seat  of  the  pus- 
tules, it  is  hardly  to  be  expected  that  any  should 
be  found  upon  the  foetus. 

A  great  shortness  of  breath  coming  on  about 
the  fifth  day  of  the  eruption,  scarcel}  leaves  any 
hopes  that  the  patient  will  survive  the  distemper. 
The  difficulty  of  breathing  is  sometimes  so  great, 
as  not  to  suiter  the  patient  to  lie  down,  or  to  have 
breath  sufficient  for  speaking  a  common  sentence. 

A  sudden  sinking  of  the  swelling  in  the  face, 
so  that  the  eyes  can  be  opened  ;  an  abrupt  stop- 
page of  the  spitting;  a  frequent  wanting  to  make 
water,  and  making  very  little  at  a  time ;  a  total 


358  Commentanes  on  the 

absence  of  all  foetor;  and  great  shiverings  ;  though 
thej  be  very  dangerous  signs,  jet  have  been  seen 
without  proving  fatal. 

Watery  bladders,  full  of  a  yellow  serum,  like 
those  raised  by  blistering  pfasters,  rise  up  among 
the  pustules  in  some  kinds  of  the  small  pox,  and 
may  shew  an  irregularity  and  malignity  ;  but  such 
patients  have  recovered. 

In  the  decline  of  the  distemper,  when  most  of 
the  scabs  had  fallen  off,  I  have  twice  seen  a  few 
pimples  with  watery  heads,  without  any  redness 
or  inflammation,  which  afterwards  maturated  and 
resembled  the  true  small  pox.  These  pustules 
were  only  in  the  soles  of  the  feet  and  palms  of 
the  hands.  In  one  child  the  pocks  were  large, 
and  fewj  for  four  days,  and  then  there  was  an 
eruption  of  very  small  and  numerous  pustules, 
from  which  the  child  with  difficulty  escaped.  In 
another  there  were  a  few  pocks,  and  the  child 
notwithstanding  was  very  restless  and  oppressed; 
after  these  were  dried,  others  broke  out,  and 
came  to  maturation ;  and  even  afterwards  one  or 
two  made  their  appearance.  The  child  died, 
though  all  the  pocks,  if  they  had  appeared  toge- 
ther, were  so  few,  that  I  never  saw  any  other  per- 
son die,  who  had  not  more.  These  are  the  only 
instances,  which  have  occurred  to  me  something 
like,  what  is  often  talked  of,  a  second  crop. 

It  has  happened  to  three  variolous  patients  in 
the  decline  of  their  distemper,  when  they  were 
thinking  of  having  a  little  meat  allowed,  and  of 
taking,  as  usual,  some  purging  medicine,  that  they 


History  and  Cure  of  Diseases.     359 

have  suddenly  become  gloomy  and  suspicious,  and 
in  forty -eight  hours  have  died  raving  mad. 

An  excessive  spitting,  which  proves  so  benefi- 
cial in  the  confluent  small  pox,  has  in  a  few  per- 
sons continued  for  several  days  after  the  decline 
of  the  distemper,  in  a  degjree  equal  to  a  common 
salivation,  and  no  harm  has  ensued. 

The  milk  of  a  woman,  who  suckled  a  child,  be- 
gan to  lessen  at  the  height  of  the  small  pox,  and 
soon  after  went  quite  away  ;  but  after  a  few  days 
it  returned  as  plentiful  as  ever. 

In  all  distempers,  it  is  considered  as  a  favoura- 
ble circumstance,  that  the  person  is  dee  from  all 
other  complaints,  with  a  constitution  naturally 
good,  and  unimpaired  :  for  when  there  is  nothing 
to  divert  the  powers  of  life  from  opposing  the  pre- 
sent illness  with  their  whole  force,  a  happy  event 
may  reasonably  be  expected  :  and  yet  a  complica- 
tion of  the  small  pox  with  other  formidable  mala- 
dies, has  in  several  instances  not  exalted  its  malig- 
nity, or  produced  a  bad  sort,  nor  disabled  the  pa- 
tient from  struggling  through  it  in  the  usual  man- 
ner. Venereal  distempers  have  often  been  join- 
ed by  a  mild  small  pox ;  and  in  a  worse  sort  they 
have  not  at  all  added  to  the  usual  danger  or  suf- 
ferings of  the  patient.  Others  have  catched  the 
small  pox,  when  they  wefe  dying  of  scrofulous 
consumptions ;  but  have  still  had  all  the  necessary 
strength  to  recover  unhurt  from  the  new  distem- 
per, and  they  have  not  appeared  to  die  a  day  the 
sooner  of  their  old  one. 


360  Commentanes  on  the 

In  a  large  town,  at  a  time  when  agues  were 
epidemical,  it  chanced  that  the  small  pox  was 
brought  in,  and  many  catched  it  before  they  were 
cured  of  their  agues.  It  was  observable,  that  the 
ague  stopped  spontaneously  in  these  patients,  as 
soon  as  the  small  pox  fever  began,  and  constant- 
ly returned  after  the  small  pox  was  over  and  one 
or  two  purges  had  been  taken.  The  two  distem- 
pers seemed  to  have  no  other  influence  over  one 
another. 

Mankind  has  hitherto  been  blessed  with  speci- 
fics for  very  few  distempers.  The  small  pox  is 
one  among  many  others,  the  proper  remedy  for 
which,  if  there  be  one,  is  left  to  be  found  out  by 
the  sagacity,  or  good  fortune,  of  futui^  physi- 
cians. Sanguine  expectations  have  been  enter- 
tained of  the  great  service,  which  the  Peruvian 
bark,  and  the  preparations  of  antimony,  and  of 
merdury,  would  do  in  opposing  the  variolous  vi- 
rus. But  such  hopes  have  upon  trial  all  dwin- 
dled away,  and  left  us  just  where  we  were.'  The 
method  therefore  of  treating  the  small  pox  will 
not  differ  from  that  which  is  contairjed  in  the  gene- 
ral doctrine  of  the  regimen  and  diet  of  the  sick  ; 
and  the  troublesome  symptoms,  which  may  arise, 
must  be  relieved,  and  the  functions  of  life  kept  as 
much  as  possible  in  their  natural  state,  by  the 
same  means  which  are  used  in  any  other  fever. 
Costiveness  in  particufer  is  as  hurtful  in  the  vaiio- 
lous  fever,  as  in  any  other  :  which  i  mention,  be- 
cause the  contrary  opitnon  formerly  prevailed, 
and  is  hardly  yet  quite  worn  out. 


History  and  Cure  of  Diseases.        361 

CHAPTER  96. 

Variola  Pusilla,     The  Chicken  Pox. 

The  chicken  pox  and  swine  pox  differ,  I  be- 
lieve, onlj  in  name  :  thej  occasion  so  little  danger 
or  trouble  to  the  patients,  that  physicians  are  sel- 
dom sent  for  to  them,  and  have  therefore  very 
few  opportunities  of  seeing  this  distemper.  Hence 
it  happens  that  the  name  of  it  is  met  with  in  very 
few  books,  and  hardly  any  pretend  to  say  a  word 
of  its  history. 

But  though  it  be  so  insignificant  an  illness,  that 
an  acquaintance  with  it  is  not  of  much  use  for  its 
own  sake,  yet  it  is  of  importance  on  account  of 
the  small  pox,  with  which  it  may  otherwise  be 
confounded,  and  so  deceive  the  persons,  who  have 
had  it,  into  a  false  security,  which  may  prevent 
them  either  from  keeping  out  of  the  way  of  the 
small  pox,  or  from  being  inoculated.  For  this 
reason  I  have  judged  it  might  be  useful  to  contri- 
bute, what  1  have  learned  from  experience,  to- 
wards its  description. 

These  pocks  break  out  in  many  without  any 
illness  or  previous  sign  :  in  others  they  are  pre- 
ceded by  a  little  degree  of  chillness,  lassitude, 
cough,  broken  sleep,  wandering  pains,  loss  of  ap- 
petite, and  feverishness  for  three  days. 

In  some  patients  I  have  observed  them  to  make 
their  first  appearance  on  the  back,  but  this  per- 
haps is  not  constant.     Most  of  them  are  of  the 

46 


^6^  Commenlaries  on  the 

common  size  of  the  small  pox,  but  some  are  less. 
I  never  saw  them  confluent,  nor  very  numerous. 
The  greatest  number,  which  I  ever  observed,  was 
about  twelve  in  the  face,  and  two  hundred  over 
the  rest  of  the  body. 

On  the  first  day  of  the  eruption  they  are  red- 
dish.    On  the  second  day  there  is  at  the  top  of 
most  of  them  a  very  small  bladder,  about  the  size 
of  a  millet-seed.     This  is  sometimes  full  of  a  wa- 
tery and  colourless,  sometimes  of  a  yellowish  li- 
quor, contained  between  the  cuticle  and  skin.     On 
the  second,,  or,  at  the  farthest,  on  the  third  day 
from  the   beginning  of  the  eruption,   as   many  of 
these  pocks,  as  are  not  broken,  seem  arrived  at 
their  full  maturity ;  and  those  which  are  fullest  of 
that  yellow  liquor,  very  much  resemble  what  the 
genuine  small  pox  are  on  the  fifth  or  sixth  day, 
especially  where  there  happens  to  be   a    larger 
space  than  ordinary  occupied  by  the  extravasated 
serum.     It   happens   to   most  of  them,  either  on 
the  first  day  that  this  little  bladder  arises,  or  on 
the  day  after,  that  its  tender  cuticle  is  burst  by 
the  accidental  rubbing  of  the  clothes,  or  by  the 
patient's  hands  to  allay  the  itching  which  attends 
this  eruption.     A  thin  scab  is  then  formed  at  the 
top  of  the  pock,  and  the  swelling  of  the  other 
part   abates,   without  its  ever  being  turned  into 
pus,  as  it  is  in  the  small  pox.     Some  few  escape 
being  burst;  and  the  little  drop  of  liquor  contain- 
ed in  the  vesicle  at  the  top  of  them  grows  yellow 
and   thick,  and  dries  into  a  scab.     On  the  fifth 
day  of  the  eruption  they  are  almost  all  dried  and 
covered   with  a  slitjht  crust.     The  inflammation 
of  these  pocks  is  very  small,  and  the  contents  of 


History  and  Cure  of  Diseases.      363 

them  do  not  seem  to  be  owing  to  suppuration,  as 
in  the  small  pox,  but  rather  to  what  is  extravasat- 
ed  immediately  under  the  cuticle  by  the  serous 
vessels  of  the  skin,  as  in  a  common  blister.  No 
wonder  therefore  that  this  liquor  appears  so  soon 
as  on  the  second  day,  and  that  upon  the  cuticle 
being  broken  it  is  presently  succeeded  by  a  slight 
scab  :  hence  too,  as  the  true  skin  is  so  little  affect- 
ed, no  mark  or  scar  is  likely  to  be  left,  unless  in 
one  or  two  pocks,  where,  either  by  being  acciden- 
tally much  fretted,  or  by  some  extraordinary 
sharpness  of  the  contents,  a  little  ulcer  is  formed 
in  the  skin. 

The  patients  scarce  suffer  any  thing  throughout 
the  whole  progress  of  this  illness,  except  some 
languidness  of  strength  and  spirits  and  appetite, 
all  which  may  probably  be  owing  to  the  confining 
of  themselves  to  their  chamber.  I  saw  two  chil- 
dren ill  of  the  chicken  pox,  whose  mother  chose 
to  be  with  them,  though  she  had  never  had  this 
illness.  Upon  the  eigth  or  ninth  day  after  the 
pocks  were  at  their  height  in  the  children,  the 
mother  fell  ill  of  this  distemper  then  beginning  to 
shew  itself.  In  this  instance  the  infection  lay  in 
the  body  much  about  the  same  time  that  it  is 
known  to  do  in  the  small  pox. 

Remedies  are  not  likely  to  be  much  wanted  in 
a  disease  attended  with  hardly  any  inconvenience, 
and  which  in  so  short  a  time  is  certainly  cured  of 
itself. 

The  principal  marks,  by  which  the  chicken 
pox  may  be  distinguished  from  the  small  pox, 
are, 


b 


364  Commentaries  on  the 

1.  The  appearance  on  the  second  or  third  day 
from  the  eruption  of  that  vesicle  full  of  serum  up- 
on the  top  ot  the  pock. 

2.  The  crust,  which  covers  the  pocks  on  the 
fifth  day ;  at  vehich  time  those  of  the  small  pox 
are  not  at  the  height  of  their  suppuration. 

Foreign  medical  writers  hardly  ever  mention 
the  name  of  this  distemper;  and  the  writers  of 
our  own  country  scarce  mention  any  thing  more 
of  it,  than  in  name.  Morton  speaks  of  it  as  if  he 
supposed  it  to  be  a  very  mild  genuine  small  pox. 
But  these  two  distempers  are  surely  totally  diffe- 
rent from  one  another,  not  only  on  account  of 
their  diflferent  appearances  above  mentioned,  but 
because  those,  who  have  had  the  small  pox,  are 
capable  of  being  infected  with  the  chicken  pox ; 
but  those,  who  have  once  had  the  chicken  pox, 
are  not  capable  of  having  it  again,  though  to  such, 
as  have  never  had  this  distemper,  it  seems  as  in- 
fectious as  the  small  pox.  I  wetted  a  thread  in 
the  most  concocted  pus-like  liquor  of  the  chicken- 
pox,  which  I  could  find  ;  and  after  making  a  slight 
mcision,  it  was  confined  upon  the  arm  of  one  who 
had  formerly  had  it ;  the  little  wound  healed  up 
immediately,  and  shewed  no  signs  of  an  infection. 
From  the  great  similitude  between  the  two  dis- 
tempers, it  is  probable,  that,  instead  of  the  small 
pox,  some  persons  have  been  inoculated  from  the 
chicken  pox,  and  that  the  distemper  which  has 
succeeded,  has  been  mistaken  for  the  small  pox 
by  hasty  and  unexperienced  observers. 

There  is  sometimes  seen  an  eruption,  concern- 
ing which  I  have  been  in  doubt,  whether  it  be 


History  and  Cure  of  Diseases.       365 

one  of  the  many  unnoticed  cutaneous  diseases, 
or  only,  as  I  am  rather  inclined  to  beheve,  a  more 
mahgnant  sort  of  chicken  pox. 

This  disorder  is  preceded  for  three  or  four  days 
by  all  the  symptoms  which  forerun  the  chicken 
pox,  but  in  a  much  higher  degree.  On  the  fourth 
or  fifth  day  the  eruption  appears,  with  very  little 
abatement  of  the  fever  ;  the  pains  likewise  of  the 
limbs  and  back  still  continue,  to  which  are  joined 
pains  of  the  gums.  The  pocks  are  redder  than 
the  chicken  pocks,  and  spread  wider,  and  hardly 
rise  so  high,  at  least  not  in  proportion  to  their  size. 
Instead  of  one  little  head  or  vesicle  of  a  serous 
matter,  these  have  from  four  to  ten  or  twelve. 
They  go  off  just  like  the  chicken  pox,  and  are 
distinguishable  from  the  small  pox  by  the  same 
marks ;  besides  which  the  continuance  of  the 
pains  and  fever  after  the  eruption,  and  the  degree 
of  both  these,  though  there  be  not  above  twenty 
pocks,  are,  as  far  as  I  have  seen,  what  never  hap- 
pen in  the  small  pox. 

Many  foreigners  seem  so  little  to  have  attend- 
ed to  the  peculiar  characteristics  of  the  small 
pox,  particularly  the  length  of  time,  which  it  re- 
quires to  its  full  maturation,  that  we  may  the  less 
wonder  at  the  prevailing  opinion  among  them, 
that  the  same  person  is  liable  to  have  it  several 
times.  Petrus  Borellus*  records  the  case  of  a 
woman,  who  had  this  distemper  seven  times,  and 
catching  it  again  died  of  it  the  eighth  time.  It 
would  be  no  extravagant  assertion   to  say,  that 

"  Hist,  and  Ol».  Rar.  Med.  Phys.  centnr.  iii.  o?)s.  10 


366  Commentaries  on  the 

here  in  England  not  above  one  in  ten  thousand 
patients  is  pretended  to  have  had  it  twice ;  and 
vs^herever  it  is  pretended,  it  will  always  be  as 
likely  that  the  persons  about  the  patient  were 
mistaken,  and  supposed  that  to  be  the  small  pox, 
which  was  an  eruption  of  a  different  nature,  as 
that  there  was  such  an  extraordinary  exception 
to  what  we  are  sure  is  so  general  a  law. 


r 


CHAPTER   97, 

Ventriculi  MorhL 

One  among  the  many  disorders  of  the  stomach 
is  a  disagreeable  sense  of  acidity  rising  from  it, 
which  is  accompanied  often  with  pain,  or  a  sort 
of  anxiety  worse  than  pain,  sickness  and  vomit- 
ing, a  sense  of  weight,  voraciousness  in  some,  and 
loss  of  appetite  in  others,  flatulence,  and  disten- 
sion of  the  stomach,  head-ach,  great  quantities 
of  phlegm,  and  a  waking  out  of  sleep  with  some 
degree  of  terrour. 

If  we  were  to  reason  upon  chemical  principles, 
nothing  seems  more  practicable,  than  to  neutral- 
ize, and  subdue  an  acid,  to  which  we  can  imme- 
diately add  whatever  we  think  proper ;  but  the 
animating  principle  makes  so  much  difference  be- 
tween a  living  stooiach  and  an  inanioiate  vessel, 
that  this,  which  appears  easy  in  theory,  has  been 
found  very  difficult  in  practice ;  and  persons  have 
been  teased  with  this  complaint  for  twenty  years, 
without  being  able  to  find  a  cure.     Lime   water, 


History  and  Cure  of  Diseases,       367 

magnesia,  testaceous  powders  in  the  quantity  of 
an  ounce  every  day,  and  alkaline  salts,  have  in  se- 
rai instances  been  tried  in  vain. 

Milk,  vegetables,  fish,  fat  of  any  kind,  a  full 
meal,  especially  with  any  exercise  soon  after  it, 
have  generally  disagreed  with  stomachs  disposed 
to  acidities,  which  they  have  much  increased. 
Acids  themselves  have  not  always  been  hurtful, 
but  have  sometimes  proved  a  relief.  Emetics 
and  Bath  waters  have  succeeded  with  some,  and 
failed  with  others.  Large  quantities  of  testa- 
ceous powders,  and  rhubarb,  have  been  the  most 
generally  useful ;  and  a  costive  habit  of  body  has 
been  always  prejudicial.  After  trying  a  variety 
of  means  for  many  years  upon  the  most  uncon- 
querably acid  stomach  which  I  ever  knew,  the 
method,  in  which  the  patient  settled,  and  which 
alone  was  able  to  keep  the  complaint  in  tolera- 
ble order,  was  the  taking  one  ounce  of  testa- 
ceous powders  every  morning,  and  drinking  a 
gallon  of  warm  water,  as  an  emetic,  every  night; 
which  course,  with  a  little  rhubarb  occasionally, 
was  pursued  for  several  years. 

The  heartburn  is  an  usual  companion  of  acidi 
ties  in  the  stomach,  differing  very  little  from  them, 
either  in  its  causes,  or  cure,  and  has  been  as  ob~ 
stinate  in  resisting  all  sorts  of  medicines.  It  has 
been  attended  with  hiccups,  eructations,  and  an 
immoderate  flow  of  saliva.  During  pregnancy 
it  is  apt  to  be  uncommonly  troublesome,  and  is 
often  added  to  the  evils  of  the  gout,  and  some- 
times to  those  of  the  jaundice.  A  disposition  to 
it  seems  to  be  born  with  some  persons,  who  have 


368  Commentaries  on  the 

been  teased  with  this  uneasy  sensation  for  the 
greatest  part  of  their  Hves.  Cutaneous  erup- 
tions, and  the  heartburn,  have  alternately  harrass- 
ed  some  persons.  One  woman,  while  she  was 
breeding,  could  find  no  relief  for  a  violent  heart- 
burn from  any  of  the  usual  remedies,  and  was  at 
last  cured  by  elixir  of  vitriol. 

i  2.  Ventriculi  Dolor. 

Inflammations,  or  cancerous  scirrhi  of  the  liver, 
spleen,  and  pancreas,  with  all  other  kinds  of  pains 
between  the  breast  and  the  navel,  are  usually 
referred  to  the  stomach  ;  and  beside  the  disorders, 
which  properly  belong  to  it,  and   have  their  ori- 

fin  there,  it  sympathises  with  all  parts  of  the 
ody  in  many  of  their  ails.  The  gout,  and  per- 
haps the  rheumatism,  wandering  pains,  and  those 
that  are  fixed,  all  sores  and  cutaneous  diseases, 
have  frequently  either  deserted  their  first  seats 
and  fallen  upon  the  stomach,  or  else  have  drawn 
it  to  suffer  together  with  the  parts  first  affected. 
With  regard  to  giddinesses,  and  head-achs,  though 
they  be  sometimes  the  causes,  yet  they  seem 
oftener  the  effects  of  stomach  disorders.  The 
diseases  of  the  womb  injure  the  stomach  in  a 
very  remarkable  manner ;  and  it  rarely  escapes 
without  pain,  or  sickness,  whenever  any  of  the 
various  irregularities  of  the  menstrua  are  com- 
plained of.  It  is  equallv  a  sufferer  in  hysteric 
and  hypochondraic  maladies,  in  all  great  pertur- 
bations of  mind,  and  in  worms,  even  those  which 
are  generally  found  only  in  the  great  intestines. 

Where  there  is  no  reason  to  suspect  and  pro» 
vide  against  any  of  these  causes,  and  where  the 


History  and  Cure  of  Diseases.       369 

pain  does  not  proceed  from  any  poison,  or  impro- 
per food ;  if  it  be  very  excessive  by  fits  with  in- 
tervals, especially  very  long  ones,  of  perfect  ease 
and  blameless  health,  there  we  have  the  great- 
est reason  to  believe  it  owing  to  gall-stones.  I 
have  noted  a  very  considerable  number  of  per- 
sons, who  for  many  years  (some  not  less  than 
twenty)  had  been  subject  to  returns  of  pains  in 
what  is  called  the  pit  of  the  stomach,  and  at  last 
the  appearance  of  the  jaundice  clearly  pointed 
out  their  origin,  or  the  voiding  of  a  gall-stone  has 
entirely  removed  them.  In  others,  after  a  fit  of 
the  jaundice,  the  same  pain  which  preceded  it, 
and  had  given  the  patients  too  much  reason  not 
to  mistake  it,  has  continued  to  torment  them  at 
irregular  times,  sometimes  without  a  yellowness, 
and  sometimes  with,  tor  at  least  twelve  years. 
Some  have  been  subject  for  a  great  part  of  their 
lives  to  a  moderate  or  dull  pain  in  the  side,  or 
about  the  stomach,  which,  as  I  judged  from  the 
appearances  after  death,  upon  their  being  open- 
ed, was  most  probably  owing  to  some  gentler 
movements  of  a  gall-stone. 

The  great  variety  of  pains  attributed  to  the 
stomach,  and  the  ditferent  causes  of  those  which 
truly  belong  to  it,  will  account  for  the  variety  of 
their  concomitant  symptoms,  and  the  different 
events  of  similar  treatments. 

Bath,  wine,  hot  medicines,  a  full  stomach,  a  ve- 
getable diet,  cathartics,  emetics,  the  state  of  preg- 
nancy, a  fit  of  the  gout,  acids,  worm  medicines, 
blisters  to  the  region  of  the  stomach  ;  all  these 
have  in  many  instances  been  found  to  do  good,  to 

47 


a70  Commentaries  on  the 

do  harm,  and  to  do  nothing  at  all.  After  due  at- 
tention has  been  used  to  discover  the  true  nature 
of  the  pain,  if  there  be  reason  to  think  that  its  ori- 
i^in  is  in  the  stomach,  and  that  it  does  not  proceed 
iVom  any  inflammatory  or  scirrhous  affection,  an 
emetic  is  generally  useful  at  first,  and  afterwards 
the  method  of  cure,  which  has  often  succeeded,  is 
either  the  drinking  of  Bath  water,  or  a  daily  use 
of  some  of  the  bitter  and  aromatic  simples,  joined 
with  as  much  rhubarb,  or  aloes,  as  may  be  neces- 
sary to  keep  off  all  tendency  to  costiveness.  A 
tea-spoonful  of  some  aromatic  tincture  has  like- 
wise been  taken  with  great  advantage  in  a  little 
water*immediately  after  dinner. 

A  great  variety  of  such  medicines  is  to  beTound 
in  all  pharmacopoeias,  out  of  which  such  may  be 
chosen  as  will  suit  most  stomachs,  and  hardly  of- 
fend any  palates.  They  are  of  frequent  and  very 
important  use  in  the  practice  of  physic,  not  only 
because  the  disorders  of  this  part  are  far  more 
common  than  those  of  any  other,  but  because  in 
unknown  distempers,  or  in  those  where  there  is 
no  good  to  be  done  by  evacuations,  and  for  which 
we  have  no  specifics,  we  can  only  aim  at  putting 
the  general  health  into  the  best  state  possible, 
the  principal  means  of  doing  which  will  be  to 
strengthen  the  stomach. 

§  3.     Morbi  Lienis, 

A  man  in  his  fiftieth  year  began  to  lose  his  flesh 

.and    strength   w^ith    some  degree  of  fever.     He 

sometimes  felt  slight  shiverings,  and   sometimes 

very  strong  ones,  returning  irregularly  during  the 


History  (mil  Cure  of  Diseases,        371 

whole  illness.  His  appetite  was  lost,  but  lie  had 
no  vomiting.  The  stools  were  regular  till  the 
two  last  months  of  his  life.  The  urine  was  in  a 
natural  state.  The  pulse  was  very  rarely  too 
cjuick.  There  was  no  tension  of  the  belly.  In 
the  second  month  of  his  illness  he  had  an  exces- 
sive pain  in  his  stomach.  Pains  of  the  loins,  hips, 
and  back,  would  come  on  suddenly,  without  con- 
tinuing above  half  an  hour.  For  a  few  days  his 
right  hand  was  swelled,  and  in  pain  ;  and  for  two 
days  the  calf  of  the  left  leg  was  too  painful  to 
bear  bemg  touched,  but  without  any  heat,  redness, 
or  swelling.  He  complained  chiefly  of  the  right 
side  of  the  belly.  During  the  last  two  months  of 
his  life  he  was  harassed  with  an  unconquerable 
diarrhoea.  This  illness  proved  fatal  about  the 
sixth  month. 

A  large  ulcer  was  found  in  one  part  of  the 
spleen,  and  the  rest  of  it  seemed  rotten.  An  ad- 
hesion had  been  formed  between  the  spleen  and 
peritonaeum.     No  other  parts  were  distempered. 

A  man  forty-two  years  old  had  complained  for 
several  months  of  loss  of  appetite,  flatulence, 
white  stools,  dark  coloured  urine,  frequent  bloody 
stools,  tenesmus,,  perpetual  nausea  and  attempts 
to  vomit,  chiefly  in  an  empty  stomach,  excessive 
restlessness,  want  of  sleep,  bleedings  at  the  nose, 
thirst,  and  light-headedness,  though  the  fever  was 
moderate.  At  last  a  sudden  vomiting  of  blood 
came  on  ;  which  returning  in  five  hours,  put  an 
end  to  his  life.  The  spleen  was  found  of  an  un- 
common  magnitude,  but  without  hardness  ;  the  in- 
side of  it  was  all  dissolved  into  a  bloody  sanies. 


ei7S  CommeiUaries  on  the 

The  glands  of  the  mesentery  were  full  of  the 
same  matter.  The  liver  was  sound.  The  por- 
tion of  the  stomach  nearest  to  the  spleen  was  in- 
flamed ;  and  there  were  signs  of  inflammation  in 
many  parts  of  the  intestines. 

A  woman  was  languishing  for  six  months  with 
a  failure  of  appetite,  and  a  swelling  of  the  left 
side  of  the  belly.  There  then  came  on  sickness, 
and  pain  of  the  stomach,  a  total  loss  of  appetite, 
a  diarrhoea  with  great  pain,  which  could  not  be 
stopped,  and  extreme  restlessness,  which  lasted 
about  six  months  longer.  The  spleen  weighed 
fifty-two  ounces,  but  was  not  ulcered,  or  scirrhous. 
The  intestines  were  in  a  natural  state,  and  there 
was  no  water  in  the  abdomen. 

§  4.  Morhi  Pancreatis, 

A  woman  had  long  been  afflicted  with  a  pain, 
as  she  said,  of  her  stomach;  which  was  excessive 
for  the  last  year  of  her  life.  She  had  no  appetite, 
and  what  she  did  get  down  was  vomited  up.  She 
could  hardly  procure  any  sleep.  The  pancreas 
was  found  scirrhous. 

Another  woman,  whose  pancreas  was  scirrhous, 
had  complained  for  seveh  years  of  a  pain  in  her 
stomach,  and  of  pains  in  her  bowels,  and  hips ;  a 
numbness  of  her  thigh  and  leg  with  a  sense  of 
cold ;  loss  of  appetite,  and  frequent  acid  vomit- 
ings.* 

*  A  man,  twenty-three  years  of  age,  had  been  afflicted  for  five 
months  with  pains  in  the  bowels,  upon  the  ceasing  of  which  the 
stomach  swelled,  and  there  came  on  indigestion,  a  diminution  of 


History  and  Cure  of  Diseases.     373 


CHAPTER  98. 
Vertigo. 


"i?' 


A  VERTIGO,  giddiness,  or  swimming  of  the  head, 
is  a  disorder  incident  to  both  sexes ;  from  which 
young  persons,  especially  females,  are  not  secure, 
though  it  be  far  more  frequently  found  in  the  old 
and  infirm. 

From  a  consideration  of  the  cases,  which  I  have 
had  an  opportunity  of  observing,  it  seems  proba- 
ble, that  many  vertigos  have  arisen  from  disorders 
of  the  stomach,  more  still  from  those  of  the  head, 
but  most  of  all  from  general  weakness.  If  I  were 
to  judge  from  the  ages,  the  constitutions,  the  ju- 
vantia  and  laedentia,  there  is  a  very  inconsiderable 
number  of  vertiginous  complaints,  which  can  be 
attributed  to  a  fulness  of  blood,  and  too  high 
health ;  therefore  in  cases,  in  which  there  may  be 
reason  to  suspect  a  plethora,  we  should  proceed 
with  caution,  and  feel  out  our  way  by  observing 
how  the  first  moderate  evacuants  were  borne, 
and  be  guided  accordingly  in  determining  the  de- 
gree of  strength,  and  the  number  of  repetitions, 
which  we  may  afterwards  venture  to  use. 

Want  of  appetite,  indigestion,  flatulence,  pain 
and  weight  in  the  stomach,  sickness,  vomiting, 
costiveness,  and  worms,  have  been  found  either  to 

the  quantity  of  urine,  and  weakness,  which  gradually  increased  ; 
lastly  a  purging  that  could  not  be  restrained.  In  the  third  month 
from  the  swelling  of  the  stomach  this  man  died.  The  pancreas 
Tvas  found  enlarged  to  an  enormous  size,  ^nd  ulcerated.    E. 


374*  Commentaries  on  the 

precede,  or  to  be  joined  with  a  swioiming  of  the 
head.  Now,  where  some  of  these  make  either 
the  only,  or  the  principal  complaints,  next  to  the 
giddiness,  we  may  reasonably  conclude,  that  the 
head  is  affected  only  secondarily,  and  that  the  ori- 
ginal seat  of  the  disorder  is  in  the  stomach. 

Tormenting  head-achs,  a  lightness  of  the  head, 
deafness,  a  singing  in  the  ears,  objects  appearing^ 
double,  temporary  blindness,  mists,  black  spots, 
or  sparks  and  flashes  of  fire  before  the  eyes,  bleed- 
ings at  the  nose,  hypochondriac' and  hysteric  ma- 
ladies, epileptic,  paralytic,  or  apoplectic  fits,  le- 
thargy, spasms,  and  convulsions  (many  of  which 
are  often  united  with  vertigos,)  are  all  such  mani- 
fest affections  of  the  head,  that  where  these  pre- 
dominate, the  giddiness  probably  has  its  origin  in 
the  brain. 

Lastly,  a  vertigo  has  been  accompanied  with 
languor,  tremblings,  faintings,  and  palpitations, 
and  has  supervened  inveterate  gouts,  obstinate 
intermittents,  asthmas,  and  other  long  disorders, 
profuse  bleedings,  and  diarrhoeas,  and  has  often 
made  one  of  the  train  of  evils  belonging  to  a  state 
of  health  much  injured  by  the  obstruction  of  some 
customary  evacuation,  as  the  menstrua,  piles, 
sores,  and  cutaneous  disorders,  or  utterly  broken 
by  intemperance,  diseases,  or  old  age.  Nor  is  it 
unknown,  that  a  vertigo  should  be  the  single  com- 
plaint, the  health  bemg  in  all  other  respects  un- 
impaired. 

Where  there  is  satisfactory  proof  that  the  ver- 
tigo is  dependent  upon  some  other  disorder,  the 


Ilistovy  and  Cure  of  Diseases,       375 

most  reasonable  manner  of  endeavouring  to  cure 
it  will  be  bj  removing  the  primary  complaint. 
But  it  must  be  owned,  that  it  is  often  difficult, 
from  the  strange  complication  of  symptoms,  to 
decide  what  is  the  precise  nature  of  the  giddiness, 
or  to  account  for  the  different  events  of  reme- 
dies in  circumstances  apparently  the  same. 

By  the  notes,  which  I  have  taken,  it  appears, 
that  a  spontaneous  vomiting  and  diarrhosa  have 
always  been  beneficial ;  that  snuff,  too  much  busi- 
ness and  fatigue,  a  crowd,  the  first  waking  in  the 
morning,  stooping,  standing,  walking,  turning  in 
bed,  and  any  alteration  of  posture,  not  weather, 
a  warm  climate,  fasting,  and  evacuations,  have 
generally  tended  to  bring  on,  or  to  aggravate  a 
swimming  of  the  head  :  that  cupping,  a  discharge 
by  the  piles,  bleeding  by  leeches,  or  by  the  lan- 
cet, blisters,  cutaneous  eruptions,  emetics,  issues, 
cold  bathing,  and  the  gout,  have  sometimes  been 
judged  to  relieve  a  vertigo ;  but  that  many  of 
them  have  been  far  oftener  useless,  especially  the 
gout,  and  blisters;  but  bleeding  by  the  lancet, 
and  strong  cathartics  have  appeared  to  do  harm 
much  more  frequently  than  good,  and  in  most  in- 
stances have  at  best  been  useless.  If  Bath  wa- 
ters have  been  innocent  in  this  malady,  they  have 
never  given  me  reason  to  think  them  beneficial. 
Cupping  has  often  failed  in  relieving  a  present 
fit,  but  it  has  in  several  instances  been  singularly 
useful  in  preventing  the  returns,  or  in  greatly 
mitigating  their  violence,  by  being  used  every 
two  months,  about  six  ounces  of  blood  being  tak- 
en away  each  time. 


376  Commentaries  on  the 

The  danger  attending  a  vertigo,  and  the  diffi- 
culty of  relieving  it,  are  to  be  estimated  from  its 
havmg  no  concomitant  ails,  or  from  their  kind  and 
number.  Where  it  is  accompanied  with  such  as 
arise  from  the  stomach,  and  especially  if  there  be 
but  a  few  of  them,  it  is  then  more  easily  remedied, 
than  when  it,  is  joined  with  affections  of  the  head, 
the  cure  of  which  is  tedious  and  uncertain.  How- 
ever, in  hypochondriac  and  hysteric  cases,  the  dan- 
fer  of  a  vertigo  is  not  much  though,  it  may  not 
e  easily  removed.  But  if  the  giddiness  be  only 
one  of  the  many  evils,  of  which  an  irreparably 
broken  state  of  health  consists,  what  hope  can 
there  be  of  a  cure  ? 

A  vertigo  unconnected  with  any  symptoms  of 
other  diseases  may  probably  be  brought  on  by 
causes  of  too  little  importance  to  create  any  dan- 
ger, or  much  disturbance  to  the  general  health; 
for  such  a  vertigo,  thoush  considerable  enoujjh  in 
some  young  men  to  endanger  their  falling,  has 
not  hindered  their  outliving  it,  and  arriving  at  a 
healthy  old  age ;  and  several  have  been  frequent- 
ly troubled  with  it  for  twenty,  or  even  thirty 
years,  with  good  health  in  all  other  respects. 


CHAPTER   99. 
Vomitus,'*' 

A  DISPOSITION  to  vomiting  is  very  various  in 
different  constitutions :  some  cannot  be  made  to 

*  See  cbap.  65,  coDcemiDg  nauseOt  or  sUkne&s  of  the  stomach. 


History  and  Cure  of  Diseases.        377 

vomit  by  any  means ;  others  not  without  extreme 
difficulty,  and.  great  pain  ;  while  seve^ral  are 
prompted  to  it  upon  the  shghtest  occasions,  and 
it  costs  them  not  the  least  trouble.  I  have  seen 
one,  who  performed  a  sort  of  rumination  :  and  if 
the  food  staid  too  long  in  his  stomach,  before 
it  was  returned  back  for  this  purpose,  it  became 
sour,  and  made  him  sick,  and  was  vomited  up. 

Vomiting  seems  so  contrary  to  nature,  that  ex- 
perience alone  could  satisfy  us  of  the  possibility 
of  its  being  continued,  as  I  have  known  it  two  or 
three  times  a  day  '  for  many  months,  or  many 
years,  with  little  or  no  ill  consequences  to  the 
health.  One  woman  told  me  she  had  for  thirty 
years  vomited  up  all  she  had  taken.  In  some 
cases,  though  all  the  food  seemed  to  be  vomited 
up,  yet  the  patients  have  thriven,  and  grown  fat. 
In  pregnancy  many  women  have  judged  that 
they  brought  up  more  than  the  whole  of  what 
had  b^en  swallowed,  and  that  for  a  considerable 
time,  without  endangering  the  life  either  of  the 
mother,  or  the  child. 

In  hard  drinkers,  and  breeding  women,  the 
morning  is  the  most  usual  time  of  vomiting;  this 
has  likewise  happened,  though  rarely,  in  some  so- 
ber men  ;  but  in  general  it  is  either  soon,  or  a 
a  few  hours  after  eating,  that  the  sickness  comcfs 
on,  which  ends  in  throwing  up  the  contents  of 
the  stomach. 

The  stomach  is  secondarily  affected  by  sym- 
pathizing, in  a  great  many  disorders,  with  other 
parts  of  the  body  :  and  it  has  many  ails  peculiar 

4« 


378  Commentaries  on  the 

to  itself,  which  hinder  it  from  receiving,  or  re- 
taining.what  has  been  swallowed  :  some  of  these 
are  manifest  after  death,  as  scirrhous  obstruc- 
tions of  the  cardia,  or  pylorus :  there  are  many 
others  connected  with  the  unknown  powers  of 
the  stomach,  which  occasion  no  alteration  of  its 
appearance  after  death,  as  far  as  our  senses  are 
able  to  judge ;  there  being  no  more  traces  of  them 
left,  than  of  a  nausea  or  vomiting  excited  by  sud- 
den ill  news,  or  the  sight  or  remembrance  of  dis- 
gustful objects.  I  remember  one,  who  for  many 
years  had  been  subject  to  a  vomiting  of  almost 
all  his  food,  and  often  of  great  quantities  of  blood, 
whose  stomach  after  death  shewed  no  signs  of 
any  disorder,  though  it  was  examined  by  some 
very  experienced  and  skilful  anatomists. 

The  matter  thrown  up  by  vomiting  has  been 
sometimes  the  food  unchanged,  sometimes  a  salt 
or  acid  liquor,  or  phlegm,  and  by  great  straining 
a  little  bile  will  be  pumped  into  the  stomacfi,  and 
thence  brought  up.  A  fat,  inflammable  matter, 
has  often  been  forced  up  by  mouthfuls  not  long 
after  eating;  and  lastly  blood,  or  a  liquor  deeply 
tinged  with  blood,  has  been  vomited  frequently, 
and  in  great  abundance,  for  several  days  together, 
with  extreme  loss  of  strength  ;  or  else  has  re- 
turned, more  like  a  chronical  affection,  in  a 
slighter  degree,  two  or  three  times  a  year  for  se- 
veral years  ;  and  though  it  have  relieved  a  pain 
of  the  stomach,  yet  even  this  chronical  sort  must 
always  be  considered  as  the  symptom  of  a  dan- 
gerous disorder  of  this  part.  The  apparent  quan- 
tity of  blood  voided  from  the  stomach  upon  these 
occasions  is  very  alarming,  and  would   be  much 


History  and  Cure  of  Diseases.      379 

more  so,  if  it  were  not  probable  that  blood  itself 
makes  often  the  least  part  of  the  bloody  liquor 
which  has  been  thrown  up.  Bloody,  or  black 
stools,  have  always  accompanied  a  vomiting  of 
blood.  Some  have  had  several  returns  of  vomit- 
ing blood,  and  apparently  in  large  quantities, 
for  several  years  :  and  in  others  their  first  vomit- 
ing of  blood  has  in  two  or  three  days  ended  in 
death.  I  know  of  no  treatment  required  for  this 
sort  of  haemorrhage  different  from  what  is  men- 
tioned in  the  Medical  Transactions,  vol.  ii.  Query 
4.  The  necessity  of  keeping  the  patient  quiet,  and 
calm,  and  cool,  appeared  very  strongly  in  one  case, 
where  the  least  drop  of  wine,  warming  the  hands 
at  the  fire,  putting  them  into  warm  water,  a  warm- 
ed bed,  a  blister,  a  purge,  and  any  ruffle  or  dis- 
turbance of  mind,  were  often  experienced  to  re- 
new the  bleeding. 

For  other  vomitings  I  have  taken  notice  that 
purging,  riding,  and  fat  of  every  kind,  have  been  pre- 
judicial ;  that  the  spontaneous  clearing  of  the  stom- 
ach has  given  no  relief;  that  an  emetic  has  some- 
times failed,  or  even  aggravated  the  complaint. 
I  was  told  by  one  person,  that  he  had  the  pa- 
tience to  persevere  in  the  use  of  emetics,  till  he 
had  taken  near  forty,  without  any  success.  How- 
ever, an  emetic  has  very  generally  proved  ser- 
viceable :  it  seems  better  calculated  to  relieve  ^ 
sudden  sickness,  than  to  cure  an  old  habitual  vo- 
miting. Bath  waters  have  been  remarkably  effi- 
cacious in  curing  the  morning  sickness  of  hard 
drinkers ;  but  has  failed  in  many  otlier  cases  of 
sickness.  The  anodyne  balsam  rubbed  in  upon 
the  stomach,  has   been  very  successful ;  and  so 


380  Commentaries  on  the  • 

likewise  has  a  blister  applied  to  the  region  of  the 
stomach.  Acids  have  been  useful  to  some  of 
these  patients,  and  Ihe  alkaline  salts  and  testa- 
ceous powders  to  others.  One  person  was  cured 
by  leaving  off  the  use  of  bread  ;  and  another  by 
drinking  water  cooled  by  ice.  But  it  must  hap- 
pen that  these  and  all  other  means  will  fail  in  stop- 
ping a  sickness  and  vomiting,  which  arises,  as  it  has 
often  done,  from  incurable  disorders  of  the  sto- 
mach or  neighbouring  bowels. 


CHAPTER  100. 

Vox. 

The  voice  without  any  pain,  or  other  disorder 
of  the  health,  has  been  weakened  so  as  never  to 
rise  above  a  whisper.  In  a  slight  degree  of  this 
complaint  the  persons  are  able  to  laugh  in  the 
usual  manner ;  but  they  are  sometimes  as  incapa- 
ble of  laughing,  as  of  speaking,  loud.  Those, 
who  have  once  experienced  such  a  failure  of 
voice,  have  been  very  subject  to  relapses.  They 
have  lost  their  voices  suddenly  without  any  pre- 
vious notice,  and  recovered  them  as  quickly  with- 
out any  apparent  cause.  Nine  out  of  ten  of 
those,  whom  I  have  seen  in  this  complaint,  have 
been  women,  and  most  of  them,  but  not  all,  have 
been  young  and  puny,  or  hysteric,  or  old  and 
infirm. 

An  inability  to  speak  beyond  a  weak  whis- 
per   has    frequently    lasted    for    many    months, 


History  and  Cure  of  Diseases.      381 

and  in  some  for  several  years  in  the  same 
uniform  manner.  Others  have  lost  their  voices 
only  for  the  morning,  or  afternoon,  of  every 
day  ;  or  for  a  certain  number  of  months  in  every 
year.  Sea  bathing,  and  blisters,  have  been  sup- 
posed to  do  some  little  service.  Internal  stimu- 
lants, and  evacuants,  have  hardly  been  innocent; 
they  have  certainly  been  useless,  and  so  have  all 
other  means  which  I  have  tried. 

The  sudden  weakness  of  voice,  of  which  I  have 
been  speaking,  is  very  different  from  that  hoarse- 
ness, which  belongs  to  bad  cough,  asthmas,  and 
catarrhs. 


CHAPTER  101. 

Urina,^ 

An  eager  desire  of  making  water  has  been 
considered  under  the  article  of  Stranguria,  and 
Prostatas  Scirrhus,  and  Calculus.  Beside  the 
causes  there  mentioned,  it  has  been  an  attendant 
upon  a  scirrhous  spleen,  and  upon  hysteric  and 
paralytic  maladies,  and  has  been  one  of  the  infir- 
mities of  old  age,  where  there  has  been  no  other 
distemper.  It  has  been  very  troublesome  to  se- 
veral in  the  night,  so  as  greatly  to  interrupt  their 
rest ;  and  it  has  teased  others  only  in  the  day- 
time, suffering  them  to  rest  quietly  in  the  night. 

A  difficulty  of  expelling  the  urine  has  not  only 
arisen  from  the  causes  mentioned   under  Stran- 

*  See  Cakulusy  Graviditas,  Ischuria^  and  Stranguria. 


ass  Commentaries  on  the 

guria,  and  Ischuria,  but  also  from  a  paralytic  ina- 
bility of  the  muscles  which  should  expel  it.  In 
one  man  the  catheter  was  necessary  for  this  pur- 
pose during  the  space  of  two  years,  after  which 
the  parts  recovered  their  use,  and  the  inconve- 
nience ceased. 

The  colour  of  the  urine  has  been  milky  in  a 
diseased  prostate  gland,  and  in  other  cases,  where 
it  might  be  owing  to  some  purulent  liquor  with 
which  it  was  mixed. 

A  large  suppuration  of  an  inflamed. sore  throat 
has  been  attended  with^  a  considerable  quantity 
of  pus  at  the  bottom  of  the  vessel  which  held  the 
urine,  for  three  or  four  days.  As  soon  as  the  ab- 
scess broke  and  discharged  itself,  this  purulent 
appearance  in  the  urine  ceased.  This  is  the  only 
instance  that  has  occurred  to  me  of  any  thing  like 
a  translation  of  matter  from  other  parts  to  the 
kidneys, 

In  some  broken  constitutions,  whenever  water 
was  made,  there  has  followed  a  great  languor,  or 
sickness  of  the  stomach. 

An  ulcer  of  the  womb  has  in  several  women 
pierced  the  rectum  and  the  bladder,  so  that  wind 
and  fseces  would  come  away  with  their  urine.  An 
ulcer,  probably  of  the  prostate  gland,  has  had  the 
same  effect  in  men :  and  one  person  believed  that 
the  breach  between  the  bladder  and  rectum  had 
been  the  consequence  of  efforts  occasioned  by  ex- 
cessive costiveness. 


History  and  Cure  of  Diseases.       383 

A  stone  in  (he  bladder,  a  diseased  prostate, 
the  fluor  albus,  frequent  miscarriages,  and  some 
rough  or  pungent  h'quors,  have  occasioned  a  heat 
of  urine,  where  there  was  no  reason  to  suspect  a 
venereal  cause. 

The  bladder  is  naturally  defended  from  the 
sharpness  of  the  urine  by  a  mucous  substance 
with  which  it  is  lined.  All  irritation,  from  what- 
ever cause  it  may  arise,  increases  this  glairy  mat- 
ter, which  will  adhere  to  the  vessel  into  which  it 
is  made,  like  starch.  It  is  very  different  from 
true  pus,  which  settles  at  the  bottom  of  the  urine 
like  cream ;  both  these  appearances  have  been 
found  to  arise  from  irritation  joined  with  some 
inflammation,  without  any  ulcer :  there  will  at 
the  same  time  be  more  or  less  eagerness  to  make 
water,  and  pain  in  making  it,  according  to  the 
degree  and  cause  of  the  irritation.  A  diseased 
prostate  gland,  inflammations  or  ulcers  of  any  of 
the  urinary  passages,  strictures  of  the  urethra, 
frequent  venereal  injuries,  and  the  stone,  or  gra- 
vely  have  been  the  common  sources  of  these  ap- 
pearances in  the  urine.  If  the  purulent  liquor 
be  considerable  in  quantity,  mixed  with  streaks 
of  blood,  and  fetid,  while  the  neck  of  the  blad- 
der is  in  a  natural  state,  it  may  probably  be  con- 
jectured that  there  is  an  ulcer  of  the  kidney, 
but  of  this  it  is  hard  to  form  a  certain  judg- 
ment. 

An  incontinence  of  urine,  though  void  of  dan- 
ger, is  yet  an  extremely  inconvenient  and  distress- 
ing infirmity.  Youth  and  old  age  are  peculiarly  lia- 
ble to  it.     In  some  weakly  boys  it  has  continued 


384  Commentaines  on  the 

from  their  infancy  almost  to  the  age  of  puberty ; 
but  much  longer  in  girls,  and  in  many  more  of 
them,  and  such  who  seemed  in  all  other  respects 
healthy.  Females  in  general*  are  more  apt  to 
have  their  urine  pass  away ;  so  that  laughing,  or 
coughing,  will  more  frequently  force  some  of  it 
from  them,  than  from  men ;  and  some  women, 
without  any  ill  health,  have  ali  their  lives  had  no 
power  to  retain  their  water.  It  is  therefore  a  less 
alarming  symptom  in  dangerous  illnesses  of  wo- 
men, than  of  men.  Among  the  morbid  causes  of 
incontinence  of  urine  may  be  reckoned  all  disor- 
ders of  the  urinary  passages,  the  cutting  for  the 
stone,  or  the  extraction  of  it  by  dilating  the  ure- 
thra, difficult  labours,  a  prolapsus  vaginae,  vene- 
real injuries,  epileptic  and  paralytic  affections,  and 
whatever  else  can  bring  on  extreme  weakness  in 
general,  or  of  the  urinary  parts  in  particular. 

A  decoction  of  the  Peruvian  bark,  and  cold 
bathing,  may  be  of  some  use  in  restoring  more 
expeditiously  the  general  strength  after  any  ill- 
ness, and  so  far  contribute  to  remedy  this  infirmi- 
ty ;  a  blister  may  also  be  applied  just  above  the 
OS  sacrum,  in  order  to  stimulate  more  particularly 
the  parts  concerned  in  retaining  the  urine.  Where 
these  have  no  effect,  either  time  alone  must  cure 
the  complaint,  or  it  must  be  considered  as  incura- 
ble ;  in  which  case,  for  the  use  of  males,  a  yoke 
has  been  contrived,  which  by  means  of  a  screw, 
compresses  the  urethra,  and  hinders  the  dripping 
of  the  water.  I  have  known  several  try  this  con- 
trivance, but  they  found  it  so  inconvenient,  that 
they  soon  laid  it  aside.  Some  in  its  room  have 
substituted  a  bladder,  in  which  the  penis  was  con- 


History  and  Cure  of  Diseases,       385 

stantly  kept  in  the  day-time  :  this  may  be  less 
cuQibersome,  but  is  not  so  neat  as  ^a  tin  vessel^ 
which  others  have  used  for  the  same  purpose. 
The  most  effectual  way  of  keeping  the  bed  dry, 
is  to  put  the' penis  and  scrotum  into  a  small  cham- 
ber-pot, and  to  keep  them  in  this  situation  all 
night.  A  little  practice  has  made  this  method 
easy  to  several  persons,  who  have  preferred  it  to 
all  others. 

Urine  made  of  a  deep  coffee  colour,  or  mani- 
festly mixed  with  a  large  quantity  of  blood,  has 
within  my  experience  very  rarely  been  the  effect 
of  any  thing  but  a  stone  in  the  urinary  passages. 
I  therefore  suppose  a  strong  probability  of  this 
cause,  wherever  I  see  this  appearance  ;  and  if  there 
be  joined  with  it  any  of  the  usual  symptoms  of  the 
stone,  I  have  no  further  doubts.  A  very  painful 
strangury  from  the  internal  or  external  use  of  can- 
tharides,  has  seldom,  if  ever,  gone  beyond  making 
a  slight  redness  of  the  water,  with  some  few 
streaks  of  blood  in  the  mucus. 

A  scirrhous  prostate  gland,  when  it  becomes 
ulcerated,  has  occasioned  some  blood  in  the  urine; 
but  the  quantity  is  very  small,  and  is  not  increas- 
ed by  riding  or  walking ;  and  whenever  this  is  the 
cause,  a  surgeon  by  examining  can  hardly  fail  to 
discover  it  by  the  swelling  and  hardness.  Can- 
cerous sores  communicating  with  any  part  of  the 
urinary  passages,  may  tinge  the  urine  with  blood; 
but  these  too  may  be  conjectured  from  the  con- 
stancy of  the  pains,  from  the  small  quantity  of 
blood,  from  its  not  being  remarkably  increased 
upon  motion,  from  the  fetid  mucus,  or  sanies,  which 

49 


886  Commentaries  on  the 

issues  from  them,  as  well  as  from  their  wanting 
several  peculiar  signs  of  the  presence  of  a  stone. 

A  blow  upon  the  loins  has  appeared  to  occa- 
sion bloody  urine;  and  I  suppose  a  blood-vessel 
maj  happen  to  burst  in  the  kidneys^  or  bladder, 
k  ,  not  only  from  such  a  violent  cause,  but  from  as 
slight  an  one  as  it  often  does  in  the  nose ;  though 
I  do  not  remember  such  an  instance.  But  1  have 
once  or  twice  known  a  very  profuse  bleeding  into 
the  urethra  from  some  of  the  neighbouring  ves- 
sels, without  any  previous  distemper,  or  extraor- 
dinary injury  of  the  part :  the  blood  kept  constant- 
ly running  out  without  any  elTort  to  make  water, 
and  without  its  being  in  the  person's  power  to 
check  it.  In  one  of  these  cases  the  bleeding  re- 
turned frequently  for  two  years,  during  which 
time  the  health  was  gradually  impaired,  and  at 
the  end  of  the  second  year  the  patient  died  ;  the 
grumes  of  blood  were  often  voided  with  difficulty, 
and  occasioned  great  distress. 

In  the  worst  kinds  of  small  pox  the  blood  is  well 
known  to  pour  out  from  the  urinary  passages,  as 
well  as  from  other  parts,  in  great  abundance. 

Many  other  causes  of  bloody  urine  are  to  be 
found  in  medical  writers,  which,  if  they  exist,  have 
never  occurred  in  my  practice.  Quiet,  and  keep- 
ing the  body  cool,  and  open,  are  all  the  means  of 
relief,  with  which  1  am  acquainted. 


History  and  Cure  of  Diseases.     387 

CHAPTER  102. 

♦  Uterus. 

A  PROLAPSUS  of  the  vagina  or  womb  Is  only  to 
be  relieved  by  a  pessary  :  it  is  apt  to  be  attended 
with  an  incontinence  of  urine. 

Several  women  have  experienced  a  sudden  and 
great  discharge  of  water  from  their  wombs ;  this 
has  happened  to  the  same  woman  more  than  once, 
and  about  the  time  of  the  menstrua  taking  their 
final  leave.  No  ill  consequences  have  followed 
this  appearance,  besides  weakness.  / 

There  has  grown  out  from  the  womb  a  fleshy 
substance  like  a  pear,  the  body  of  it  being  much 
larger  than  the  stalk.  This  has  extended  itself 
so  as  to  be  perceivable  in  the  vagina  in  straining 
upon  going  to  stool.  The  great  evil  arising  irom 
this,  is  a  constant  discharge  of  blood  irom  the  di- 
lated parts,  which  discharge  will  necessarily  con- 
tinue till  the  excrescence  be  removed.  An  expe- 
rienced accoucheur  assured  me  that  he  had  taken 
away  near  twenty  of  these  by  passing  a  ligature 
as  near  as  possible  to  the  part  adhering  to  the 
womb  :  in  a  few  days  after  this  has  been  done,  the 
mass  falls  off,  and  the  remaining  stalk  putrefies 
away,  requiring  nothing  but  frequent  injections  of 
an  infusion  of  camomile  flowers.  He  told  nie  this 
operation  had  been  generally  successiul,  and  it 
has  proved  so,  where  i  liave  known  it  performed. 

The  furor  uterinus  docs  not  always  arise  fron^ 
a  preternatural  state  of  the  womb,  but,  sometimes^ 


388  Commeniaries  on  the 

at  least,  differs  not  from  common  madness;  the 
mind  no  longer  under  the  guidance  of  reason,  is 
made  a  prey  to  such  thoughts  as  work  it  up  to 
the  oestrum  venereum,  instead  of  those  \V1iich 
might  inflame  it  with  religious  zeal,  ambition,  or  a 
desire  of  revenge.  I  have  seen  it  not  only  in  the 
young  and  middle-aged,  but  in  a  dying  old  wo- 
man, who  had  long  been  in  a  broken  state  of 
health,  from  which  circumstances,  as  well  as  from 
the  decency  of  her  character,  it  may  be  judged 
that  all  delight  in  the  objects  upon  w^hich  she  rav- 
ed, had  been  long  passed  and  forgotten.  Besides, 
it  happens  sometimes  to  the  other  sex,  that  mad- 
ness lets  loose  the  passion  of  lust,  as  well  as  those 
of  fear,  or  anger. 

The  womb,  as  well  as  the  breasts  of  women,  is 
subject  to  scirrhous  tumours,  which  slowly  turn 
to  incurable  ulcers.  This  happens  at  the  same 
time  of  life,  with  similar  disorders  of  the  breasts, 
that  is,  generally  after  the  age  of  forty.  The 
first  symptom  is  often  a  return  of  the  menstrual 
discharge  after  it  had  long  ceased  :  but  this  is  no 
certain  sign  ;  for  its  re-appearance  has  sometimes 
proceeded  from  other  causes,*  as  well  as  from  a 
scirrhous  state  of  the  womb.  In  some  women  the 
first  alarm  is  given  by  a  copious  discharge  of  a  te- 
nacious mucus  like  jelly,  or  of  a  thinner  fluid,  like 
the  fluor  albus  :  this  has  continued  for  one  or  two 
years,  intermixed  now  and  then  with  a  discharge 
of  blood,  before  any  of  the  more  violent  symptoms 
have  come  on.  These  are,  pains  of  the  womb,  in 
the  groin,  in  the  loins,  in  one  or  both  of  the  hips, 

*  See  chapter  G2. 


History  and  Cure  of  Diseases,       389 

and  in  the  thighs ;  pains  in  going  to  stool,  and  in 
making  water,  with  a  tenesmus,  and  a  frequent 
call  to  make  water,  a  manifest  fulness  of  the  ab- 
domen, and  at  the  same  time,  a  sense  of  empti- 
ness, and  a  hectic  fever.  The  discharge  after- 
wards becomes  jellow,  green,  or  black,  and  fetid; 
and  the  pains  are  so  excessive,  as  hardly  to  be  en- 
dured without  benumbing  the  sense  of  them  in 
some  degree  by  large  quantities  of  opium.  They 
are  scarcely  increased  by  the  motion  of  a  carriage. 
In  a  few  cases  the  ulcer  of  the  womb  has  eaten  a 
passage  to  the  bladder,  and  to  the  rectum.  All 
these  symptoms  do  not  happen  in  every  case  ;  but 
a  very  few  of  them  are  sufficient  to  shew  the  na- 
ture of  the  disease,  even  before  it  has  been  ascer- 
tained by  a  naidwife's  examination  of  the  womb. 

The  extract  of  hemlock  washed  down  with  a 
decoction  of  the  Peruvian  bark  is  at  least  inno- 
cent in  this  disorder;  but  I  have  had  very  little 
reason  to  judge  this,  or  any  other  medicine,  to  be 
of  much  avail  in  curing,  or  checking  the  progress 
of  the  cancer.  One  woman  was  very  remarkably 
relieved,  while  she  was  taking  the  extract,  and  at 
the  same  time  using  an  injection  of  the  decoction 
of  hemlock ;  the  pains  almost  vanished,  and  the 
womb  remained  in  such  a  quiet  state  for  some 
years,  as  to  give  very  little  interruption  to  her 
usual  amusements,  or  manner  of  living.  But  in 
most  other  cases  no  good  could  be  done,  but  by 
administering  in  a  proper  manner  some  prepara- 
tion of  opium. 


THE  CONCLUSION. 

It  might  be  expected,  that  the  experience  of 
fifty  years  spent  in  the  practice  of  Physic,  would 
have  taught  me  more,  than  I  here  appear  to  have 
learned,  of  distempers,  and  their  remedies.  I  rea- 
dily confess  my  knowledge  of  them  to  be  slight, 
and  imperfect;  and  that  a  considerable  share  of 
this  imperfection  is  chargeable  upon  my  want  of 
ability  to  make  a  better  use  of  the  opportunities  I 
have  had :  but  at  the  same  time  it  must  be  allow- 
ed, that  some  part  must  be  put  dov^Tn  to  the  very 
great  difficulty  of  making  improvements  in  the  me- 
dical art.  This  is  too  evident  from  the  slow  pro- 
gress which  has  been  made,  though  men  well  qua- 
lified by  their  learning,  experience,  and  abilities, 
have  for  above  two  thousand  years  been  commu- 
nicating to  the  world  all  they  could  add  by  just 
reasoning  to  the  facts  collected  by  attentive  ob- 
servation. Whoever  applies  himself  lo  the  study 
of  nature,  must  own  we  are  yet  greally  in  the 
dark  in  regard  even  to  brute  matter,  and  that  we 
know  but  little  of  the  properties  and  powers  of 
the  inanimate  creation :  but  we  have  all  this  dark- 
ness to  perplex  us  in  studying  animated  nature, 
and  a  great  deal  more  arising  from  the  unknown 
peculiarities  of  life  ;  for  to  living  bodies  belong 
many  additional  powers,  the  operations  of  which 
can  never  be  accounted  for  by  the  laws  of  lifeless 
matter.  The  art  of  healing  therefore  has  scarce- 
ly hitherto  had  any  guide  but  the  slow  one  of  ex- 


THE    CONCLUSION.  391 

perience,*  and  has  yet  made  no  illustrious  advan- 
ces by  the  help  of  reason ;  nor  will  it  probably 
make  any,  till  Providence  think  fit  to  bless  man- 
kind by  sending  into  the  world  some  superiour 
genius  capable  of  contemplating  the  animated 
world  with  the  sagacity  shewn  by  Newton  in  the 
inanimate,  and  of  discovering  that  great  principle 
of  life,  upon  which  its  existence  depends,  and  by 
which  all  its  functions  are  governed  and  directed, 

;^§ova,  «««,    Stobcei  Eclog.  Phys.  lib.  i.  page  19. 


CONTAINING 

1.  A  Sketch  of  a  Preface  designed  for  the  Medical 

Transactions,  1767. 

2.  Observations  on  the  Chronical  Rheumatism. 

3.  On  the  Pulse. 

4.  On  opening  a  Vein  in  Haemorrhages. 


1 .     A  Sketch  of  a  Preface  designed  for  the  Me- 
diced  Transactions,  1767. 

The  world  has  had  more  than  sufficient  expe- 
rience how  far  either  building  upon  the  ancients, 
or  upon  reasonings  a  priori,  is  likely  to  improve 
us  in  natural  knowledge.  By  laying  aside  both 
these  methods,  and  by  attentively  observing  na- 
ture itself,  a  greater  progress  has  been  made  dur- 
ing the  last  century,  than  had  been  till  that  time 
from  the  days  of  Aristotle. 

The  manner  in  which  these  observations  have 
been  communicated  to  the  world,  appears  to  have 
had  no  small  share  in  the  advantages  which  have 
been  gained.  The  several  learned  societies  in 
Europe,  which  have  joined  in  forming  one  com- 
mon stock  of  knowledge,  have  received  contribu- 
tions from  many,  who  would  otherwise  never 
have  published  the  remarkable  phaenomena  which 
50 


391  APPENDIX. 

chance  had  thrown  in  their  way.  They  have 
likewise  hindered  many  from  overlaying  their  Ht- 
tle  original  knowledge,  by  compilations  from  oth- 
ers, or  by  crude  reasonings  of  their  own,  which 
they  might  think  necessary  to  furnish  out  a  just 
volume.  Thus  they  have  had  the  good  effects  of 
inviting  some  to  tell  all  that  they  knew,  and  have 
lessened  the  temptation  which  others  might  have, 
to  say  more  than  they  knew. 

It' is  a  misfortune  to  the  world,  that  the  several 
societies  of  physicians  in  Europe  have  not  more 
generally  adopted  the  same  plan  ;  as  there  can  be 
no  question  made  of  its  being  attended  with  as 
much  success  in  their  particular  study,  as  it  has 
been  in  that  of  every  other  part  of  nature.  It  is 
high  time  that  this  should  be  done,  as  physicians 
have,  like  other  natural  philosophers,  (uUj  run 
the  round  of  commenting  the  ancients,  and  con- 
triving theories,  and  teaching  systeniatical  doc- 
trines in  many  a  celebrated  school ;  and  just  with 
the  same  success. 

The  deference,  which  is  sometimes  required  in 
physic  to  the  authority  of  the  ancients,  would  in- 
cline any  one  to  suspect,  that  the  improvements 
in  the  art  of  healing  had  not  kept  pace  with  those, 
which  have  been  made  in  other  branches  of  natu- 
ral knowledge.  Philosophers  have  long  ago 
thrown  off  Aristotle's  tyranny  ;  yet  some  physi- 
cians still  choose  to  wrangle  about  the  meaning 
of  the  ancients,  rather  than  to  consult  nature  her- 
self. Are  they  afraid  of  approaching  her  imme- 
diate presence,  without  making  use  of  the  inter- 
cession of  Hippocrates  and  Galen  ?  and  is  that  re- 


APPENDIX.  395 

verence  to  be  still  paid  to  her  once  faithful  minis- 
ters, which  is  properly  due  to  nature  alone  ;  not- 
withstanding all  that  Bacon,  and  Harvey,  and 
Newton,  and  our  other  great  reformers,  have  wit- 
nessed against  this  mistaken  veneration  ?  In  works 
of  genius  the  ancients  are  unquestionably  our  su- 
periours,  and  best  patterns;  but  in  that  sort  of 
knowledge  which  depends  wholly  upon  experience, 
the  latest  writers  must  in  general  be  the  best. 
But  this  disagreeable. and  unpopular  topic  needs 
be  pursued  no  further;  not  only  because  every 
scholar  must  be  loth  to  say,  or  hear,  any  thing 
against  the  ancients  ;  but  because  they  are  in  rea- 
lity very  little  read  and  attended  to  by  practition- 
ers, though  the  fashion  of  quoting  and  recommend- 
ing them  be  still  prevalent  in  some  modern  wri- 
ters. 

It  has  been  an  old  dispute  among  physicians, 
whether  the  empirical,  or  rational  method  of  cur- 
ing diseases  was  to  be  preferred.  If  by  the  em- 
pirical method  be  meant  that  which  is  founded  on 
facts  recorded  by  others,  or  observed  by  ourselves, 
it  must  be  allowed,  that  by  this  means  only  has 
the  practice  of  physic  been  established.  Fact, 
and  repeated  experiments,  have  alone  informed  us 
that  jalap  will  purge,  andipecacuanha  vomit,  that 
the  poppy  occasions  sleep,  that  the  bark  will  cure 
an  ague,  and  that  quicksilver  will  salivate.  If  we 
examine  the  whole  materia  medica,  and  the  whole 
practice  of  physic,  we  shall  not  find  one  efficacious 
simple,  nor  one  established  method  of  cure,  which 
were  discovered,  or  ascertained,  by  any  other 
means. 


h 


396  APPENDIX. 

Experience  may,  in  politics  and  morality,  be 
called  the  teacher  of  fools ;  but  in  the  study  of 
nature,  there  is  no  other  guide  to  true  knowledge : 
accordingly  the  practice  of  physic  has  been  more 
improved  by  the  casual  experiments  of  illiterate 
nations,  and  the  rash  ones  of  vagabond  quacks, 
than  by  the  reasonings  of  all  the  once  celebrated 
professors  of  it,  and  theoretic  teachers  in  the  seve- 
ral schools  of  Europe ;  very  few  of  whom  have 
furnished  us  with  one  new  medicine,  or  have 
taught  us  better  to  use  our  old  ones,  or  have  in 
any  one  instance  at  all  improved  the  art  of  curing 
diseases.  Hence,  though  they  have  been  applaud- 
ed during  the  lives  of  their  disciples,  yet  disinte- 
rested and  impartial  posterity  has  suffered  each 
succeeding  master  of  this  sort  to  be  gathered  to 
his  once  equally  famous  predecessors,  and  to  be, 
like  them,  in  his  turn  utterly  unread  and  forgot- 
ten. 

It  is  necessary  to  be  upon  our  guard  even 
against  experience  itself,  when  delivered  in  a  sys- 
tem ;  the  very  notion  of  which  seems  to  imply, 
that  the  facts  and  observations  are  not  barel)'  re- 
lated, but  are  ranged  into  some  method,  and  form- 
ed into  one  body  dependent  upon  what  the  com- 
piler takes  to  be  their  general  cause  or  nature ; 
and  hence  arises  the  great  danger  of  their  being 
misrepresented,  in  order  to  make  them  fit  more 
exactly  the  several  places  which  are  assigned 
them.  The  Jews  were  commanded  to  build  their 
altar  with  stones  unhewn  and  untouched  by  any 
tool ;  and,  in  like  manner,  the  best  materials  of 
natural  knowledge  are  the  plain  facts  themselves, 
just  as  they  come  from  nature ;  he  who  pretends 


m 


APPENDIX.  397 

to  new  model  and  polish  them,  in  order  to  their 
being  adapted  more  perfectly  to  his  system,  has 
utterly  polluted  them,  and  made  them  unfit  for 
the  altar  of  truth. 

Nor  let  any  one  apprehend,  that  physic  will  be- 
come too  easy  a  study,  by  making  it  thus  wholly 
depend  upon  experience  ;  and  that,  hy  losing  the 
fence  of  learned  theories,  it  will  be  an  easy  prey, 
open  to  the  invasions  of  every  ignorant  pretender. 
For,  whatever  weight  there  may  be  in  this  objec- 
tion, it  will  be  found  to  be  greatest  against  the 
way  of  theory  and  hypothesis ;  this  being  much 
the  cheapest,  and  most  expeditious  method  of 
making  a  physician.  A  heated  imagination  will 
always  supply  us  with  knowledge,  such  as  it  is, 
much  faster  than  the  ordinary  course  of  nature. 
The  road  of  experience  is  tedious,  and  requires 
great  judgment,  as  well  as  patience.  The  con- 
trary to  this  seems,  indeed,  to  be  the  general  per- 
suasion ;  for  every  one  is  apt  to  fancy  himself  a 
competent  judge  of  medical  experience,  and  is 
ready  to  trust  any  one  else  who  pretends  to  it. 
But,  to  form  a  right  judgment,  a  man  must  be 
trained  to  a  habit  of  thinking  attentively  by  a 
learned  education,  and  should  not  only  be  ac- 
quainted with  the  nature  of  the  materia  medica, 
but  also  with  the  several  hypotheses,  with  the 
false  philosophy,  the  mistakes  in  language,  and 
other  sources  of  errour,  upon  which  the  supposed 
virtues  of  remedies  have  been,  and  are  still  often 
founded.  And  after  all,  it  will  be  found  extreme- 
ly difficult,  to  determine  rightly  upon  the  intricate 
and  contradictory  evidence  which  is  frequently 
brought  for  the  effects  of  medicines. 


398  APPENDIX. 

The  Peruvian  bark  was  known  and  tried  in  Eu- 
rope, at  least  forty  years  before  its  virtues  and 
dose  could  be  properly  ascertained.  The  solvent 
power  of  medicines  for  the  stone  of  the  bladder, 
is  what  lies  much  more  obvious  to  the' senses,  than 
the  efficacy  of  most  other  medicines ;  and  yet,  in 
the  late  instance  of  Mrs.  Stephens's  remedy,  how 
difficult  a  thing  was  it  found  to  determine  this, 
though  tried  in  a  variety  of  cases,  which  were  di- 
ligently attended  by  the  ablest  judges  ?  No  won- 
der, therefore,  that  out  of  the  innumerable  catho- 
licons,  or  universal  medicines,  with  which  every 
nation  and  age  has  swarmed  for  these  last  thou- 
sand years,  not  one  has  survived  ;  and  out  of  as 
great  an  inundation  of  speci6cs,  or  remedies  for 
particular  diseases,  which  have  readily  found,  pa- 
trons* sufficient  to  give  them  a  fair  trial,  the  bark 
and  quicksilver  are  almost  the  only  two,  which 
have  stood  the  test  of  time  and  general  experi- 
ence. 

As  therefore  the  art  of  healing  owes  so  little  to 
any  other  teachers,  and  so  much  to  experience, 
the  College  of  Physicians  in  London  is  desirous 
of  collecting  the  experience  of  its  members,  and 
their  correspondents,  in  the  manner  which  has 
answered  so  well  in  the  Royal  Society  here,  and 
m  many  other  literary  associations  abroad,  and  is 
therefore  ready  to  receive  medical  papers  in  order 
to  communicate  such  as  are  approved  to  the  pub- 
lic. 


*  Coramuni  enim  fit  vitio  naturae,  ut  invisis,  latitantibus,  (al.  in- 
tentatis)  atque  incognitis  rebus  magis  confidamus.  Caesar  de  Bell. 
Civ.  lib.  ii.  c.  iv. 


APPENDIX.  399 

For  want  of  such  an  opportunity  of  communi- 
cating their  knowledge,  it  has  often  happened, 
that  many  judicious  practitioners  have  carried  the 
whole  experience  of  forty  years,  spent  in  an  exten- 
sive practice,  with  them  to  the  grave,  much  of 
which  would,  probably,  by  the  means  now  pro- 
posed, have  been  preserved,  and  might  have  been 
as  useful  to  posterity,  as  it  had  been  to  their  con- 
temporaries. 

Medical  papers  are,  indeed,  received  into  our 
own  Philosophical  Transactions,  as  well  as  into 
the  journals  and  memoirs  of  many  other  learned 
societies;  but  it  is  apprehended,  that  if  a  society 
of  physicians  professed  to  receive  such  papers, 
and  communicate  them  to  the  public,  there  would 
be  many  more  communicated,  and  perhaps,  with 
better  choice,  and  they  would  more  certainly  come 
into  the  hands  of  physicians,  without  being  lost  in 
the  crowd  of  other  papers. 

If  the  present  intentions  of  the  College  are  se- 
conded, as  there  is  reason  to  hope  they  will  be, 
they  may  excite  in  every  practitioner  belonging 
to  it,  a  more  constant  attention  to  all  the  circum- 
stances of  remarkable  and  instructive  occurren- 
ces ,-  they  may  strengthen  the  habit  of  noting, 
and  of  recollecting,  and  of  forming  conclusions 
from  what  passes  before  him,  and  prove  the  means 
of  preserving  some  observations,  which  would 
otherwise  be  lost,  not  only  to  the  public,  but  to 
the  observer  himself. 

Though  the  principal  view  of  the  College  be 
to  perfect  the  history  of  diseases,  and  to  ascertain 


400  APPENDIX. 

the  effects  of  medicines,  yet  any  other  papers  will 
be  received,  which  in  any  manner  relate  to  medi- 
cal subjects. 

Many,  who  have  communicated  their  observa- 
tions to  the  world,  have  purposely  picked  out 
such  as  were  rare  and  extraordinary,  such  as  have 
seldom  happened  before,  and  may  never  happen 
again.  Now,  though  these  may  be  worth  pre- 
serving, for  almost  all  facts  teach  something,  yet 
surely  the  preference  ought  not  to  be  given  to 
such  as  these,  unless  the  chief  end  of  our  writing 
be  to  amuse  the  reader  by  gratifying  his  curiosity. 
If  a  man  have  only  leisure  to  give  either  his  un- 
usual cases  and  cures,  or  such  as  may  frequently 
occur  in  every  day's  practice,  it  would  be  more 
for  the  reader's  use,  if  not  for  the  writer's  credit, 
to  draw  up  only  the  latter,  and  leave,  according 
to  the  proverb,    ®ctv^otT»  fAu^oi?, 

It  were  also  to  be  wished,  that  writers  would 
not  confine  themselves  to  relate  only  their  suc- 
cessful practice,  but  that  they  would  have  the  cou- 
rage to  tell  us  the  ineffectual  and  hurtful.  It  is 
sometimes  almost  as  useful  to  know  the  laedentia 
(especially  if  they  are  likely  to  throw  themselves 
in  our  way,  if  not  carefully  avoided)  as  the  juvan- 
tia ;  and  any  physician  of  great  experience  might 
make  a  very  useful  paper,  by  giving  an  account 
only  of  such  medicines  and  methods  of  cure, 
which  he  had  found  to  be  useless  and  inconve- 
nient. 

Single  cases  of  the  catalepsy,  hydrophobia,  and 
other  rare  distempers,  may  be  worth  the  relating: 


APPENDIX.  401 

but  histories  of  particular  cases,  where  the  distem- 
per is  a  common  one,  and  of  such  effects  of  medi- 
cines as  occur  every  day,  must  be  endless,  and 
would  rather  tire  and  oppress,  than  instruct  the 
reader.  Whatever  important  additions,  or  excep- 
tions to  the  common  practice,  are  contained  in 
such  cases,  would  much  better  be  drawn  out  by 
the  author,  who  can  best  do  it,  and  presented  by 
themselves,  without  giving  along  with  them  a  tire- 
some hihtory  of  common  appearances,  which  e\e- 
ry  one  had  often  seen,  and  was  well  acquainted 
with  Ions:  before. 

There  may  be  some,  but  it  is  hoped  there  will 
not  be  much  occasion  for  bespeaking  the  reader's 
candour,  if  some  papers  thus  published  by  the 
College  should  appear  less  deserving  of  his  no- 
tice. In  so  small  a  society,  where  the  members 
are  all  personally  known  to  one  another,  some- 
thing must  be  expected  to  be  given  to  civility  ;  as 
an  author,  who  is  usually  not  the  best  judge  of 
his  own  works,  may  now  and  then  have  a  fond- 
ness for  some  paper  beyond  its  merit ;  and  the 
College  may  determine  more  out  of  regard  to  the 
writer,  than  to  the  piece.  But  this,  we  trust, 
will  not  often  happen,  nor  in  any  flagrant  instan- 
ces ;  and  little  matters,  which  may  be  imputed  to 
this  cause,  the  considerate  reader  will  easily  over- 
look, as  without  some  indulgence  of  this  kind,  the 
design  could  hardly  be  carried  on,  and  consequent- 
ly, the  papers  of  more  importance  would  be  lost. 


51 


102 


APPENDIX. 


2.     Of  the  Chronical  Rheumatism. 

The  disease  called  the  chronical  rheumatism, 
which  often  passes  under  the  general  name  of 
rheumatism,  and  is  sometimes  supposed  to  be  the 
gout,  is  in  reality  a  very  different  distemper  from 
the  genuine  gout,  and  from  the  acute  rheumatism, 
and  ought  to  be  carefully  distinguished  from  theiil 
both. 

It  is  attended  with  little  or  no  fever,  and  most 
commonly  with  no  very  great  pain ;  and  in  both 
these  respects  it  differs  from  the  acute  rheuma- 
tism. The  swellings  are  in  most  instances,  though 
not  in  all,  very  great,  but  have  hardly  any  red- 
ness ;  they  are  not  particularly  apt  to  begin  in 
the  foot,  or  if  they  do,  they  soon  leave  it,  and 
pass  on  to  other  parts  of  the  limbs,  several  of 
which,  one  after  another,  become  the  seat  of  the 
distemper  in  the  very  first  fit.  The  true  arthri- 
tic- pains  are  different  in  all  these  circumstances, 
if  we  except  the  swelling,  as  well  as  in  their  in- 
tensity. An  attention  to  these  particulars  will 
enable  us  in  the  very  first  week  of  the  fit  to  form 
a  judgment  of  its  nature,  and  will  shew  us  to 
which  of  these  three  it  belongs.  Afterwards  this 
will  be  further  evinced  by  the  extreme  weakness 
it  occasions  in  the  limbs,  and  the  severe  shock 
which  it  gives  to  the  constitution  and  general 
health,  patients  being  often  more  disabled  by  a 
single  attack  of  the  chronical  rheumatism,  than 
they  are  by  annual  returns  of  the  true  gout  for 
many  years. 


APPENDIX.  -  403 

Arthritic  patients  seem  peculiarly  liable  to  the 
palsy,  and  apoplexy,  beside  having  the  use  of  their 
limbs  destroyed  in  consequence  of  frequent  inflam- 
mations of  the  joints,  or  contractions  of  the  mus- 
cles :  but  all  this  mischief  is  in  these  patients  the 
work  of  a  long  time,  and  to  many  of  them  it  hap- 
pens either  not  at  all,  or  but  in  a  slight  degree ; 
while  the  first  fit  of  the  chronical  rheumatism,  if 
it  be  continued,  as  it  often  has  been,  for  several 
months,  will  do  irreparable  injury  to  the  limbs, 
bringing  on  a  state  of  almost  paralytic  weakness, 
and  greatly  impairing  their  use  during  the  whole 
life.  A  frequent  repetition  of  the  disease  has  in 
six  years  totally  taken  away  the  use  of  all  the 
limbs ;  and  in  some  very  bad  cases  this  has  hap- 
pened even  in  the  first  year. 

Nor  is  this  rheumatism  less  strongly  marked  by 
the  continuance  of  the  first  fit,  from  which  few  are 
so  fortunate  as  to  be  released  under  three  or  four 
months ;  while  the  first  fit  of  the  true  gout,  sel- 
dom lasts  twenty  days.  It  is  much  more  apt  to 
return,  than  the  acute  species,  under  which  many 
have  laboured  once,  without  ever  experiencing  it 
a  second  time.  But  though  the  chronical  rheu- 
matism most  usually  repeats  its  visits,  yet  their 
intervals  are  far  more  unequal,  than  those  of  the 
gout.  It  may  in  some  cases  come  on  regularly 
once  a  year,  for  a  (ew  years;  but  others  suffer 
two  or  three  returns  within  the  same  year ;  and 
some  patients  have  been  hardly  ever  free  for  se- 
veral years ;  while  others  again  have  had  inter- 
missions for  five,  or  six,  or  even  for  near  twenty 
years. 


404  APPENDIX. 

Cramps  are  very  common  in  this  disorder,  as 
well  as  in  the  gout. 

The  swellings,  which  it  occasions,  are  often  re- 
markably great,  and  some  degree  of  them  will 
continue  for  many  years,  or  for  the  patient's  life, 
particularly  in  the  wrists,  and  sometimes  in  the 
fingers,  and  ankles.  The  pains  are  not  subject, 
like  those  of  the  acute  sort,  to  be  increased,  but 
are  rather  relieved  by  the  warmth  of  a  bed.  I 
have  observed  very  few  instances  where  the  con- 
trary to  this  has  happened. 

The  stomach  and  bowels  are  much  oftener,  and 
more  readily  affected  in  this  rheumatism,  than  in 
the  true  gout.  Pain,  nausea,  and  universal  lan- 
guor, are  its  ordinary  effects  in  these  parts.  Up- 
on the  application  of  a  vt^arm  plaster,  or  liniment, 
to  the  affected  limb,  the  distemper  has  presently 
been  thrown  upon  the  bowels ;  and  in  some  in- 
stances, pains  have  seized  the  limbs  and  stomach 
alternately.  Sometimes  the  anguish  of  the  abdo- 
minal viscera,  and  the  weakness  of  the  extren)i- 
ties,  make  tliis  disease  bear  no  little  resemblance 
to  the  colic  of  Poitou  ;  and  they  both  bring  on  a 
rapid  decline  of  the  general  health. 

The  distemper  of  which  I  am  speaking,  seems 
confined  to  no  sex,  and  hardly  to  any  age.  The 
rich  and  the  poor  are  equally  liable  to  it.  It  has 
happened  to  me  to  see  rather  more  women  than 
men  afflicted  with  it.  In  some  it  has  begun  at  the 
age  of  twelve  years;  in  others  not  till  they  were 
past  sixty.      Is  it  not  in  some  degree  hereditary  ? 


APPENDIX.  405 

The  chronical  rheumatism  for  a- few  days  ap- 
pears to  be  a  milder  distemper  than  either  the 
acute  sort,  or  the  goqt :  but  in  its  consequences, 
that  is,  in  the  great  weakness,  or  total  loss  of 
power  it  produces  in  the  limbs,  and  in  the  mis- 
chief done  to  the  general  state  of  the  body,  it  is 
much  more  formidable  than  either  of  them  ;  and 
being  so  very  different  in  its  symptoms,  as  well  as 
in  the  event,  it  would  be  useful  if  it  were  distin- 
guished by  a  peculiar  name,  which  might  prevent 
its  being  confounded  with  other  disorders,  by  be- 
ing called  a  spurious  and  wandering  gout,  or  a 
chronical  rheumatism. 

The  waters  of  Bath  and  Buxton,  preparations 
of  antimony  and  of  quicksilver,  seabathmg,  cold 
and  warm  bathing,  blisters,  and  warm  liniments, 
have  in  some  of  these  patients  been  thought  ser- 
viceable; but  all  these,  together  with  bleeding, 
purging,  sweating,  and  electrification,  have  been 
of  no  use  to  others  ;  some  have  even  thought  them 
hurtful.  A  course  of  mercurial  medicines  has 
with  great  reason  been  suspected  of  bringing  on 
something  like  this  distemper  in  many  persons ; 
and  it  has  appeared  to  do  so  in  the  same  person 
five  or  six  times,  that  is,  as  often  as  the  mercury 
was  repeated. 

It  is  not  surprising,  if  against  a  disease  which 
has  been  so  imperfectly  discriminated,  as  the 
chronical  rheumatism,  no  certain  method  of  cure 
should  have  been  discovered.  Wherever  that  is 
the  case,  the  physician  will  fully  discharge  his 
duty  by  attending  to  the  troublesome  syi^iptoms, 
which  it  is  often  in  his  power  to  relieve,  to  the 


406  APPENDIX. 

great  ease  and  comfort  of  the  sick,  and  by  assist- 
ing nature  in  bringing  all  the  functions  of  life  as 
near  as  raay  be  to  their  natural  state  in  health. 
A  prudent  use  of  ^pium  will  be  one  of  the  means 
of  obtaining  these  very  desirable  ends ;  and  much 
good  may  also  be  done  by  supporting  the  appe- 
tite and  digestion  with  Peruvian  bark,  and  bitters, 
and  other  stomachic  medicines  ;  the  class  of  which 
appears  to  have  some  specific  power  not  only  in 
this  distemper,  but  likewise  in  the  gout. 


3.     Remarks  on  the  Pulse. 

Read  at  the  College  of  Physicians,  July  7th,  1768. 

All,  who  begin  the  study  of  physic,  must  find 
in  the  doctrine  of  the  pulse,  as  collected  from  me- 
dical writers  by  Bellini  and  others,  a  great  deal 
which  they  do  not  understand  ;  and  all,  1  imagine, 
who  have  advanced  a  little  in  the  practice  of  phy- 
sic, can  have  very  little  doubt  of  its  not  being  un- 
derstood by  the  authors  themselves.  Such  mi- 
nute distinctions  of  the  several  pulses,  if  they  do 
not  exist  chiefly  in  the  imagination,  at  least  have 
little  place  in  the  knowledge  and  cure  of  diseases. 
Time  indeed  has  so  fully  set  them  aside,  that 
most  of  these  names  of  pulses  are  now  as  unheard 
of  in  practice,  as  if  they  had  never  been  given  : 
and  it  may  be  doubted,  whether  some  of  those, 
which  are  retained,  are  perfectly  understood,  or 
applied  by  all  to  the  same  sensations,  and  have 
in  every  one's  mind  the  same  meaning.  I  have 
more  than  once  observed  old  and  eminent  practi- 


c 


APPENDIX.  407 

doners  make  such  different  judgments  of  hard, 
and  full,  and  weak,  and  small  pulses,  that  I  was 
sure  they  did  not  call  the  same  sensations  by  the 
same  names. 

It  is  to  be  wished,  therefore,  that  physicians  in 
their  doctrine  of  pulses,  and  descriptions  of  cases, 
had  attended  more  to  such  circumstances  of  thti 
ulse,  in  which  they  could  neither  mistake,  nor 
e  misunderstood.  Fortunately  there  is  one  of 
this  sort,  which  not  only  on  this  account,  but  like- 
wise for  its  importance,  deserves  all  our  attention. 
What  1  mean  is,  the  frequency  or  quickness  of  the 
pulse,  which,  though  distinguished  by  some  wri- 
ters, I  shall  use  as  synonymous  terms.  This  is 
generally  the  same  in  all  parts  of  the  body,  and 
cannot  be  affected  by  the  constitutional  firmness 
or  flaccidity,  smallness  or  largeness  of  the  artery, 
or  by  its  lying  deeper  or  more  superficially  ;  and 
is  capable  of  being  numbered,  and  consequently 
of  being  most  perfectly  described  and  communi- 
cated to  others. 

"  The  degrees  of  quickness  of  the  pulse  belong- 
ing to  the  several  ages,  and  distempers,  have  been 
taken  notice  of  by  few  physicians  in  their  writ- 
ings ;  and  as  many  observations  are  necessary  to 
settle  this  doctrine,  what  I  have  made  and  am  go- 
ing to  relate,  may  be  of  use  towards  confirming, 
correcting,  or  enlarging  those,  which  have  been 
made  by  others.  When  the  number  of  pulsations 
is  mentioned  without  any  time  being  specified,  a 
minute  is  to  be  understood. 

The  pulse  of  children  under  two  years  old 
should  be  felt  when  they  are  asleep;  for  their 


408 


APPENDIX. 


pulses  are  greatly  quickened  by  every  new  sensa- 
tion, and  the  occasions  of  these  are  perpetually 
happening  to  them  while  they  are  awake.  The 
pulse  then  of  a  healthy  infant  asleep  on  the  day 
of  its  birth,  is  between  130  and  140  in  one  mi- 
nute ;  and  the  mean  rate  for  the  first  month  is 
J 20;  for  during  this  time,  the  artery  often  beats 
as  frequently  as  it  does  the  first  day,  and  I  have 
never  found  it  beat  slower  than  108.  During  the 
first  year  the  limits  may  be  fixed  at  108  and  120. 
For  the  second  year  at  90  and  108.  For  the 
third  year  at  80  and  100.  The  same  will  very 
nearly  serve  for  the  fourth,  fifth,  and  sixth  years. 
In  the  seventh  year  the  pulsations  will  be  some- 
times so  few  as  72,  though  generally  more  :  and, 
in  the  twelfth  year  in  healthy  children  they  will 
often  be  not  more  than  70 ;  and  therefore,  except 
only  that  they  are  much  more  easily  quickened 
by  illness,  or  any  other  cause,  they  will  differ  but 
little  from  the  healthy  pulse  of  an  adult,  the  range 
of  which  is  from  a  little  below  60  to  a  little  above 
80.  It  must  be  remembered,  that  the  pulse  be- 
comes more  frequent,  by  ten  or  twelve  in  a  mi- 
nute, after  a  full  meal. 

If  the  pulse  either  of  a  child,  or  an  adult,  be 
quickened  so  as  to  exceed  the  utmost  healthy  li- 
mit by  ten  in  a  minute,  it  is  an  indication  of  some 
little  disorder.  But  a  child  is  so  irritable,  that 
during  the  first  year,  a  very  slight  fever  will  make 
the  artery  beat  140  times,  and  it  njay  beat  even 
160  without  danger;  and  as  there  begins  to  be 
some  difficulty  in  counting  the  pulse  when  the 
motion  is  so  rapid,  the  thirst,  quickness  of  breath- 
ing, averseness  from  food,  and  above  all,  the  want 


APPENDIX.  409 

of  sleep,  enable  us,  better  than  the  pulse,  to  judge 
of  the  degree  of  fever  in  infants. 

A  child  of  two  years  may  die  of  an  inflammato- 
ry (ever,  though  the  artery  beat  only  144  times  in 
a  minute ;  and  I  have  seen  a  child  of  four  years 
recover  from  a  fever,  in  which  it  beat  1-^)6  times  ; 
and  one  of  nine,  where  it  beat  152. 

If  the  pulse  of  a  child  be  15  or  20  below  the 
lovTest  limit  of  the  natural  standard,  and  there  be 
at  tlie  same  time,  signs  of  considerable  illness,  it 
is  a  certain  indication,  that  the  brain  is  affected, 
and  conseqjiently  such  a  quiet  pulse,  instead  of 
giving  us  hope,  should  alarm  us  with  the  proba- 
bility of  imminent  danger. 

In  adults  ill  of  an  inflammatory  {ever.,  the  dan- 
ger is  generally  not  very  great,  where  the  beats 
are  fewer  than  100;  120  shew  the  beginning  of 
danger ;  and  they  seldom  exceed  this  number  un- 
attended with  deliriousness,  and  where  the  pa- 
tient does  not  die.  There  are  two  exceptions  to 
this  observation  :  the  first  is^  that  before  some  cri- 
tical swelling  or  deposit  of  matter  begins  to  shew 
itself  in  fevers,  the  pulse  will  be  so  rapid  and  in- 
distinct, as  hardly  to  admit  of  being  counted  ;  but 
I  have  known  it  certainly  not  less  than  150,  and 
yet  the  patient  has  recovered.  Acute  rheuma- 
tisms afford  a  second  exception  ;  in  which  the  ar- 
tery will  often  beat  above  120  times  without  any 
sort  of  danger;  and  in  both  these  cases  we  may 
remark,  that  the  appetite  and  senses,  and  sleep, 
and   strength  are  put  less  out  of  their  natural 

52 


410  APPENDIX. 

state,  than  where  the  hTe  of  the  patient  is  in  immi- 
nent danger. 

Though  it  be  difficult  to  count  above  140 
strokes  in  a  minute,  if  they  be  unequal  in  time  or 
in  strength,  jet  where  they  have  been  very  dis- 
tinct, I  have  been  able  to  count  180. 

Asthmatic  persons  are  often  seized  with  an  un- 
commonly bad  fit,  arising  probably  from  some 
great  inflammation  of  the  lungs;  and  here,  if  the 
pulse  exceed  120,  they  very  rarely  recover. 

In  an  illness  where  the  pulse  all  at  once  be- 
comes quiet  from  being  feverishly  quick,  while  all 
the  other  bad  signs  are  aggravated,  it  is  a  proof, 
not  of  the  decrease  of  the  disorder,  but  of  the  les- 
sened'  irritableness  of  the  patient,  the  disease 
being  translated  to  the  brain ;  and  a  palsy,  apo- 
plexy, or  death,  is  to  be  apprehended. 

In  low  fevers,  and  in  exhausted  old  men,  the 
pulse  will  often  continue  below  100,  or  even  90, 
and  yet  the  distemper  be  attended  with  want  of 
sleep,  deliriou&ness,  restlessness,  and  a  parched 
tongue,  and  end  in  death,  without  any  comatous  or 
lethargic  appearances. 

Scirrhous  disorders  of  any  of  the  viscera  in  an 
inflamed  state,  cancers,  and  gangrenous  or  other- 
wise ill-conditioned  large  ulcers,  usually  occasion 
a  gradual  loss  of  flesh,  a  heat,  thirst,  and  a  pulse 
between  90  and  120  for  many  months.  This 
state  of  the  body  is  called  a  hectic  fever;  and 
some  judgment  may  be  formed  of  the  degree  of 


APPENDIX.  4ii 

danger  by  the  frequency  of  the  pulse.  But  a 
quickened  pulse  more  certainly  denotes  danger, 
than  a  natural  one  does  security,  where  there  are 
ulcers,  or  vvheie  disorders  of  the  viscera  are  sus- 
pected. I  have  known  persons  die  of  cancerous 
ulcers  of  the  anus,  testicles,  prostate  gland,  and 
of  almost  all  the  viscera,  without  ever  shewing 
any  preternatural  quickness  of  the  pulse.  It  is 
observable  in  hectic,  as  w^eli  as  in  rheumatic  pa- 
tients, that  they  will  eat  with  a  tolerable  appetite 
for  many  months,  and  bear  little  journies,  with 
such  a  quickness  of  pulse,  as  in  acute  fevers  would 
be  joined  with  an  averseness  from  all  food,  and 
an  inability  to  keep  out  of  bed. 

From  these  remarks  it  appears,  that  tiie  pulse, 
though  in  many  cases  an  useful  index  of  the  state 
of  the  health,  yet  is  no  certain  one  in  ail ;  and  that, 
without  a  due  regard  to  other  signs,  it  may  mis- 
lead us:  a  good  pulse  (which  1  have  known  in 
comatous  fevers)  with  deliriousness,  rapid  loss  of 
appetite,  and  strength,  sleeplessness,  quickness  of 
breathing,  and  great  thirst,  would  afford  very  lit- 
tle hope  ;  and  a  bad  one  without  any  of  these 
might  be  harmless. 

I  remember  two  young  women  ill  together  with 
others  in  the  same  house,  of  the  same  infectious 
fever;  the  pulse  of  one  of  which  was  never  above 
84,  and  the  pulse  of  the  other  was  always  ex- 
tremely quick,  and  I  once  counted  it,  when  I 
thought  her  d}ing,  180.  Both  of  them  recover- 
ed, and  the  latter  quite  beyond  my  expectation ; 
for,  except  in  this  in^'ance,  1  hardly  remember  any 
one  recover  from  such  a  fever,  wliere  the  pulse 


412  APPENDIX. 

exceeded  120.  But  the  first  of  these  was  stupid, 
insensible  of  the  coming  away  of  her  water  or 
stools,  and  perhaps  her  brain  was  affected  coma- 
touslj,  which  might  make  her  pulse  so  slow. 

The  pulses  of  women  will  sometimes  exceed 
what  1  have  mentioned  as  the  highest  limit  of  the 
healthy  standard,  and  sometimes,  though  more 
rarely,  those  of  men  ;  but  the  pulses  of  men  afford 
more  exceptions  in  falling  short  of  the  lowest. 
There  are  very  few  healthy  men,  whose  pulses 
are  more  than  90;  and  I  knew  one,  whose  chief 
distemper  was  the  age  of  fourscore,  in  whom  for 
the  last  two  years  of  his  life,  I  only  once  counted 
so  many  as  42  pulsations  ;  but  they  were  seldom 
above  30,  and  sometimes  not  more  than  26 ;  and 
though  he  seemed  heavy  and  torpid,  yet  he  could 
go  out  in  a  carriage,  and  walk  about  his  garden, 
receive  company,  and  eat  with  a  tolerable  appe- 
tite. 

I  saw  another,  whose  pulse,  as  I  was  told,  was 
sometimes  in  the  beginning  of  his  illness  not  above 
12  or  16  in  a  minute  ;  but  in  this,  and  all  other  in- 
stances where  it  is  below  40,  I  suspect  that  the 
artery  beats  oftener  than  it  can  be  felt ;  because 
such  slow  pulses  are  usually  unequal  in  their 
strength,  and  some  of  the  beats  are  so  faint  as  but 
just  to  be  perceived  ;  so  that  others,  probably, 
still  fainter,  are  too  weak  to  make  a  sensible  im- 
pression on  the  finger. 

Some  books  speak  of  intermitting  pulses  as  dan- 
gerous signs,  but,  1  think,  without  reason ;  for 
such  trivial  causes  will  occasion  them,  that  they 


APPENDIX.  413 

are  not  worth^jregarding  in  any  illness,  unless 
joined  with  otner  bad  signs  of  more  moment. 
They  are  not  uncommon  in  health,  and  are  often 
perceived  by  a  peculiar  fe'el  at  the  heart  by  the 
persons  themselves  every  time  the  pulse  inter- 
mits. A  woman  above  fifty  years  of  age,  who 
died  of  a  cancer  of  the  womb,  had  from  her  youth 
frequently  experienced  this  sort  of  intermittent 
pulse ;  and  that  the  cause  of  this  intermission 
might  be  discovered,  she  was  opened  after  her 
death,  as  she  had  desired  she  might  be.  It  was 
done  by  a  very  experienced  and  able  anatomist : 
but  he  could  discover  not  the  least  appearance  of 
any  thing  preternatural  in  the  pericardium,  or 
heart,  or  any  of  the  great  vessels  belonging  to  it; 
so  that,  for  aught  that  appeared  to  the  contrary, 
she  might,  notwithstanding  this  complaint,  have 
died  of  old  age. 

Many  persons  will  likewise  have  unequal  pulses 
without  any  other  sign  of  111  health.  1  have  met 
with  two,  who  in  their  best  health  always  had 
pulses  very  unequal  both  in  their  strength  and  the 
spaces  between  them;  upon  their  growing  ill, 
their  pulses  constantly  became  regular;  and  it 
was  a  never-failing  sign  of  their  recovery,  when 
their  arteries  began  again  to  beat  in  their  usual 
irregular  manner. 

It  is  often  supposed  that  great  pain  will  quick- 
en the  pulse  :  1  am  more  sure  that  mere  pain  will 
not  always  do  it,  than  I  am  that  it  ever  will.  The 
violent  pain  occasioned  by  a  stone  passing  from 
the  kidneys  to  the  bladder,  is  often  unattended 
with  any  quickness  of  the  pulse ;  and  the  exces- 


414 


APPENDIX. 


sive  and  almost  intolerable  torture  produced  by  a 
gall-stone  passing  through  the  gall-ducts,  has  in 
no  instance  quickened  the  pulse  beyond  its  natu- 
ral pace,  as  far  as  I  have  observed,  though  it  be  a 
disorder  which  occurs  so  very  frequently :  and 
this  natural  state  of  the  pulse,  joined  with  the  ve- 
hement pain  about  the  pit  of  the  stomach,  affords 
the  most  certain  diagnostic  of  this  illness.  I  have 
seen  a  man  of  patience  and  courage  rolling  upon 
the  floor  and  crying  out  through  the  violence  of 
this  pain,  which  I  was  hardly  able  to  lull  into  a 
tolerable  state  with  nine  grains  of  opium  given 
within  twenty-four  hours,  to  which  he  had  never 
been  accustomed,  and  yet  his  pulse  was  all  the 
time  as  perfectly  quiet  and  natural,  as  it  could 
have  been  in  the  sweetest  sleep  of  perfect  health. 


4.     On  opening  a   Vein  in  Hamorrhages, 

Read  at  the  College  of  Physicians,  December  11,  1771. 

It  has  been  the  practice  of  physicians  to  take 
away  blood  from  the  arm,  or  foot,  in  order  to  slop 
violent  haemorrhages  from  some  other  parts,  which 
do  not  admit  of  a  topical  application.  . 

If  it  be  intended  by  this  practice  to  weaken  the 
power  of  the  heart,  and  to  give  the  lips  or  ends  of 
the  broken  blood-vessel  a  chance  of  collapsing,  or 
of  being  plugged  up  by  means  of  a  more  languid 
circulation,  would  not  all  this  be  as  likely  to  hap- 
pen after  the  patient  had  been  equally  weakened 
by  losing  the  same  quantity  of  blood  from  the  ori- 


APPENDIX.  415 

ginal  rupture  ?  And  in  the  mean  time  he  might 
stand  a  chance  of  its  stopping  spontaneously,  be- 
fore he  was  reduced  to  that  degree  of  weakness. 

It  seems  probable,  from  all  the  experience  which 
I  Ijave  had  of  such  cases,  that  where  the  hsemorr- 
hage  proceeds  from  the  breach  of  some  very 
large  vein,  or  artery,  there  the  opening  of  a  vein 
will  not  stop  the  efflux  of  blood  ;  and  it  will  stop 
without  the  help  of  the  lancet,  when  it  proceeds 
from  a  small  one  :  in  the  former  case,  bleeding 
does  no  good  ;  and  in  the  latter,  by  an  unnecessa- 
ry waste  of  the  patient's  strength,  it  will  do  harm. 
But  if  the  opening  of  a  vein  be  intended  to  stop 
an  haemorrhage  by  deprivation  or  revulsion,  may 
it  not  be  questioned,  whether  this  doctrine  be  so 
clearly  established,  as  to  remove  all  fears  of  hurt- 
ing a  person,  who  has  already  lost  too  much 
blood,  by  a  practice  attended  with  the  certain  loss 
of  more  ? 

The  best  remedies  seem  to  be  a  cool  air  ;  quiet ; 
a  very  sparing  mild  nourishment,  administered  in 
small  quantities  at  a  time ;  drinks  acidulated  with 
any  acids  ;  opiates  in  small  doses  (for  any  strong- 
perturbation  of  mind  will  often  occasion  a  return 
of  the  bleeding  ;)  and  lastly,  keeping  the  body 
moderately  open.  A  very  experienced  physician 
told  me,  that,  by  the  help  of  gently  purging  with 
some  of  the  salts,  he  had  done  more  good  in  ex- 
cessive losses  of  blood  from  the  nose,  than  by  any 
other  means.  I  do  not  lay  any  great  stress  upon 
the  use  of  internal  astringent  remedies,  because  it 
does  not  appear  likely  from  reasoning  that  they 
should  do  any  service  ;  and  I  am  far  from  being 


416  APPENDIX.    , 

convinced  by  experience,  that  they  ever  do,  ex- 
cept perhaps  in  haemorrhages  of  the  primae  viae. 
They  may  sometimes  have  appeared  to  be  attend- 
ed with  success,  because  there  is  but  a  very  small 
proportion  of  haemorrhages,  not  ovi^ing  to  exter- 
nal violence,  which  would  prove  fatal,  though  no 
means  were  used  to  stop  them ;  and  hence  it  has 
happened,  that  a  great  number  of  other  external 
and  internal  medicines  have  been  very  undeser- 
vedly advanced  to  the  rank  of  specifics  in  this 
complaint.  Saccharum  saturni  has  appeared  to 
me  to  have  the  best  title  to  be  called  an  internal 
specific  :  and  it  is  very  unfortunate,  that  the  use- 
ful quality  of  this,  and  other  preparations  of  lead, 
should  be  joined  with  others  of  such  a  dangerous 
nature  ;  for  I  hardly  ever  saw  a  case,  in  which  the 
probable  good  to  be  expected  from  them  as  styp- 
tics, would  counterbalance  the  many  certain  mis- 
chiefs arising  from  their  internal  use. 


ENGLISH  INDEX. 


A  Page. 

BDOMEN 11 

Ague 146 

Aneurysm 15 

Angina  pectoris     .      .     .  292 

Ascarides 49 

Asthma      ......  50 

Bath  Water        ....  58 

Bowels,  inflammation  of  .  210 

Bowels,  pains  of     .     .    .  224 

Breast,  pains  of     .      .     .  336 

Breasts 292 

Bristol  Water    ....  64 

Broken  State  of  Health    .  352 

Bronchocele        ....  64 

Carbuncle 82 

Catalepsy        291 

Chicken  Pox        ....  361 

Child-bearing      .     .     .     .  318 

Cold  and  Catarrh     .     .     .  108 

Colic  of  Poitou        ...  309 

Consumption       ....  299 

Cough 348 

Diabetes 113 

Diarrhoea 116 

Diet 1 

Dropsy       173 

Drunkenness        ....  125 

Dysentery 123 

53 


Page. 

Ears,  disorders  of    .     .     .  56 

Epilepsy 126 

Erysipelas,  or  St.  Antho- 
ny's Fire      ....  135 
Eyes,  disorders  of    .     .     .  263 

Fainting 230 

Fever 141 

Fingers,  nodes  of      .     .     .  119 

Fistula       160 

Flatulence 220 

Fluor  Albus 161 

Giddiness        373 

Gleet .  165 

Gout 26 

Haemorrhage        .     .     .     .  414 

Head-ach        74 

Head-ach,  intermitting     .  80 

Head,  water  in    .     .     .     .  172 

Hectic  Fever       :     ...  150 

Hiccup 327 

Hip,  disease  of  ...  .  86 
Hooping  Cough  .  .  .  350 
Hydrophobia  ....  173 
Hypochondriacal  and  Hy- 
sterical Affections  .  180 
Jaundice,  and  Diseases  of 

the  Liver    ....  189 

Itch 90 


418 


INDEX. 


Itching  of  the  Skiu       .     .  317 

Legs,  diseases  of      .     .     .  87 

Loins,  pain  in      ....  232 

Lymphatic  Glands        .     .  235 

Madness 221 

Measles 252 

Menstrua 241 

Method  of  curing  Diseases  4 

Miscarriage     .     •     .     .     .  12 

Mouth,  disorders  of      .     .  230 

Nettie-Rash 137 

Nose  bleeding     ....  260 

Numbness 345 

Nyctalopia,  or  Night-blind- 
ness       269 

Pain 120 

Pains,  wandering      .     .     .  122 

Palpitation  of  the  Heart  .  271 

Palsy  and  Apoplexy      .     .  273 

Pancreas  diseased    .     .     .  372 

Pedicularis  Morbus      .     .  299 

Phlegm 314 

Piles 168 

Pregnancy 166 

Prostate  Gland  scirrhous   .  315 

Pulse .406 

Purple  Spots       ....  318 

Rectum 13 

Rheumatism        ....  320 

Rheumatism  Chronical     .  402 

Rupture 172 

St»  Vitus's  Dance    ,     .     .  83 


Scald  Head 103 

Scarlet  Fever     ....  15 

Scrofula 338 

Semen  Virile      ....  326 

Shingles 101 

Sickness  of  the  Stomach   .  362 

Skin,  diseases  of    .     .     .  90 

Small  Pox 353 

Sore  Throat  .    ,    .     .     .  19 

Spasms 329 

Spitting  of  Blood    ...  332 

Spleen  diseased      .     .    .  370 

Stomach,  pain  of     .     .     .  368 

Stomach,  sourness  of    .     .  366 

Stone 65 

Strangury 335 

Suppression  of  Urine    .     .  227 

Suppuration  of  the  Jaw    .  271 

Swallowing Ill 

Tenesmus 343 

Testicles 343 

Thirst 328 

Thrush 25 

Tremor ,  347 

Voice    .......  380 

Vomiting    ......  376 

Urine 381 

Waking  with  Fright     .     .  140 

Wens 335 

Womb,  disorders  of    .     .  387 

Worms      ......  233 


LOCKKD 
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